creative writing on a doctor

Reclaiming Reflection: Creative Writing and the Medical Humanities (1)

Poetry and Reflection: a powerful tool for learning

This post is part of a series over the next three days on the theme of Creative Writing and Medical Humanities by Dr Eleanor Holmes (pen name Eliot North ).

As a GP Tutor I’ve delivered seminars on the patient centred medicine (PCM) component of Newcastle University’s Medical Undergraduate (MBBS) course to 1 st and 2 nd year students, for the past three years. Professional reflective practice is taught and assessed across all five years of the curriculum.

The ability to reflect and learn from clinical encounters is central to medical education and continuing professional development. Delivered within a creative context, I believe written reflection can also be an important tool to foster wellbeing and resilience in healthcare students and professionals.

Working in an increasingly overstretched and under resourced system such as the NHS, in which clinician burnout and mental health problems are on the rise, the question of how we reflect on the difficult and complex nature of care is becoming ever more important to address.

Stating that the answer might be found outwith Medicine may seem heretical, but it is my belief that we need to look outwards to move forwards. The Arts and Humanities, like Health and Medicine, explore and reflect upon the human condition. What therefore can we learn from each other?

My last seminar with my first year group was entitled ‘Professional Reflective Practice 2.’ After a year of working together trust, an essential element of clinical reflection, had been built within the group. I used my own writing, a poem called He Blew Me a Kiss, as a launch point for discussion, which was published under my pen name Eliot North.

He Blew Me a Kiss

She liked Frank, they connected

despite his expressionless face. Behind the wound-up limbs and tremor

a gentle man shone out from the mask.

When she visited they would share a cuppa,

chat about this and that. Do the ‘medication shuffle’;

a two-step dance they both knew well.

She’d heard about stem cell research.

How they’d taken swabs from patients’ skin. Growing stem cells

from skin cells in dishes, right there in the lab up the road.

These stem cells would then become brain cells.

Models of Parkinson’s just like Frank’s. For testing newer and better

medications and perhaps one day even a cure.

The last time she saw Frank it was snowing

but he insisted on accompanying her out. Standing by the gate like a sentinel

he’d wave her off that one last time.

Later she’d think of stem cells like kisses

blown on the winter air. The moment captured in her rear-view mirror;

A hand lifted slowly, toward a frozen face.

Published by EuroStemCell ‘Tales from Within: Imaginative Non-Fiction on Stem Cells,’ 2013. (Frank is a pseudonym)

http://www.eurostemcell.org/he-blew-me-kiss-eliot-north

I have found that reading a poem aloud, that I’ve written myself, is an extremely powerful learning tool. There are obvious medical elements I can draw out regarding Parkinson’s Disease and stem cell research, but more than that the poem makes an important statement about connectedness, communication, the complex and varied role of a doctor as well as the limitations of medical science. It speaks to students about the importance of getting to know patients and continuity of care; how embracing the humanity in an encounter can be both powerful and revelatory.

The moment captured in the poem will live with me until the day I die, reading it always chokes me up; I choose to show this emotion to my students. We as clinicians who teach, whether in seminars or on the wards and in clinics, are hugely powerful role models. By stating and showing that this encounter moved me I am by example saying, “It’s OK to show emotion.” This leads to discussions about professionalism, boundaries and clinician wellbeing linked to the evidence base that demonstrates better patient outcomes when doctors show that they are emotionally affected when breaking bad news.

I wrote this poem many years after the event, it was something that sat in my brain waiting to come out. I wish that I’d been able to share it with the man who inspired the poem but he died some years before I got it down on paper. It was a EuroStemCell competition, partnered with the Centre for Regenerative Medicine in Edinburgh that spurred me to write it.

The challenge to submit an ‘imaginative non-fiction’ poem that incorporated stem cell research brought this encounter immediately to mind, the link between stem cells and Parkinson’s a way to explore how I felt about this patient. Discussing the creative process and the fact that I write under a pen name and changed the patient’s name forms a nice link to the importance of anonymity, confidentiality and consent, as well as patient and doctor voice.

With my students I then facilitated a creative guided writing exercise on a memorable clinical encounter followed by small group work, drawing and writing Haiku. The seminar culminated in poster presentations delivered by the students to the group. The results were insightful, empathetic and moving; their use of metaphor and close observation giving authenticity to the explorations they had made of encounters with patients and carers struggling to cope with dementia, a potential diagnosis of cancer and the communication difficulties witnessed for a patient with learning disabilities, linking this to issues of capacity and consent.

As someone who uses creative outlets as a way of coping with the stresses of practicing medicine, it amazes me that the word ‘creative’ can strike fear in to the hearts of medical students and healthcare professionals alike. I believe that by embracing creativity and essentially our inner child, written reflection can be much more than a required component of assessment and appraisal. All humans have the capacity to be creative, no matter how much they protest to the contrary. The skill lies in being able to coax it out of them.

Acknowledgements

All of the work I’m currently doing in this area is in collaboration with Sue Spencer with whom I wrote the guided writing framework I used above with my students, influenced by reading the books and on-line resources below. We are delivering a ‘Reflection of Clinical Encounters’ workshop using creative writing methodologies in November 2016 for the Staff Development Programme, School of Medical Education, Newcastle University.

Writing Poems by Peter Sansom, Bloodaxe 1994

The Poetry Toolkit – The Poetry Trust 2010, available as a free PDF download http://www.thepoetrytrust.org/images/uploads/pdfs/Toolkit%20for%20Teachers.pdf

Australian author and doctor Melanie Cheng reflects on the benefits of creative writing for healthcare professionals

Topic: Arts, Culture and Entertainment

A close up of a pen pressing into a perscription pad, the torso of someone in a white doctor's coat in the background.

Holistic approaches to medicine are slowly being integrated into mainstream medical education. ( Getty Images: Hero Images )

Doctors often see us at our most vulnerable, whether we're beaten down by a persistent head cold or saying goodbye to loved ones.

They know our intimate inner workings (literally) and they are often present at life-changing moments, like discovering a pregnancy or a serious illness.

These moments of intimacy, which doctors have on a daily basis, also happen to be the stock-in-trade of creative writers: the instances our humanity is most visible and vibrant.

With a few notable exceptions (Anton Chekhov chief among them), however, doctors and writers tend to be placed on remote ends of the intellectual spectrum — one end analytical and rational, the other intuitive, abstract and emotional.

But there is a growing number of people within the medical community who think the separation of the disciplines is nonsensical — and more importantly, a missed opportunity.

Melbourne GP and author Melanie Cheng is one of those people.

"A good fiction writer is, by definition, putting themselves inside the head of someone whose life experience is not their own," she says.

A black and white photo of a young Chekhov in a greatcoat and a bus driver's hat, lounging on a verandah.

Chekhov once said, "Medicine is my lawful wife and literature is my mistress". ( Supplied: Wikimedia commons. )

"And I think a good GP, in particular, should really be trying to see the world from the view of the patient that's sitting across from them."

The reality of life as a clinician, though, is quite different.

"They have done some studies that looked at the levels of empathy in medical students before they enter medical training and at the end of it, and their empathy levels actually seem to drop," Cheng says.

"I think it may be a bit of a coping mechanism, because if you get emotionally involved in every single patient's life, that could be quite a burden to bear."

But for Cheng, whose first novel Room for a Stranger came out last month, creative writing is an opportunity to exercise the imaginative muscle that she uses to better treat and care for her patients.

"I don't feel like I'm switching brains or modes when I go from work to home and start writing," she says.

"I think they [medicine and writing] enhance and complement each other, and they come from the same essential place."

Happier doctors

Cheng broke on to the Australian literary scene in 2017 with Australia Day, a collection of short stories that won the Victorian Premier's Literary Award for Fiction.

Born in Adelaide and growing up in Hong Kong, she had been writing informally since high school, but went on to study medicine, graduating in 2003.

A watermelon red book cover with white text and a blue line drawing of a parrots wing.

The cover of Melanie Cheng's 2019 novel Room for a Stranger. ( Supplied: Text Publishers )

Upon completing her GP training, Cheng found she had some unexpected time on her hands.

"I found this Creative Doctors network … that was started by a doctor call Tony Chu. So I made the effort, I didn't have kids at the time, I went along to one of their meetings," she says.

What Cheng found at these conferences "invigorated" her: "They were doctors that were doing writing, photography, painting, performance. Tony Chu himself was this screenplay writer," she explains.

"I'd been used to going to the hospital wards and seeing a lot of these very tired and very grumpy and overworked doctors, and even in general practice, a lot of really burnt-out GPs.

"What struck me when I went to see this Creative Doctors network was that they really seemed happy — and it was a bit of a light-bulb moment."

Hilton Koppe , a GP with almost three decades' practice and involvement in training medical professionals, had his own light-bulb moment 16 years ago: he uses writing exercises in his sessions to replenish his trainees' "wells", or stores, of empathy.

"[As health professionals] we're asked … to be present for others, and to bear witness to their suffering," he explains.

For GPs, this kind of transaction might happen "20, 30, 40 times a day, sometimes more," he says.

"It's tiring, and it's easy for the well to become empty."

A typical exercise in one of Dr Koppe's training sessions might involve asking his students to write up a patient-doctor scenario in narrative form, and then identify what emotions each "character" might be feeling.

"And then we play with the words, and the emotions also to create some metaphors and poems … it's amazing what they come up with."

A man in his late fifties smiles into the camera wearing a white shirt and his hair in a short crop.

Dr Koppe has presented keynote speeches on his techniques all over the world including England, Portugal and New Zealand. ( Supplied: Doctors of Australia )

Dr Koppe says that, in general, trainees have been "incredibly positive" about the experience.

He speculates that part of the reason might be neurological:

"The traditional medical way … you follow a linear approach. This is sort of opening it up into a slightly different way of exploring things," he says.

"It probably releases different neuro chemicals that make people feel a bit happier or alert or awake."

Dr Koppe also points to a number of studies that suggest reflective writing practices have an impact on our physical health, in particular the immune system and responses to pain and viral illnesses.

Healthier patients

"[In] my undergraduate training … I didn't receive a lot of teaching about empathy at all," Cheng reflects.

"It was all about symptoms and signs, and occasionally people would talk about an holistic approach, but it was almost done in a kind of dismissed way at the end, as an add-on."

Cheng thinks this cavalier approach to human connection, combined with enormous time and resourcing pressure, results in doctors who don't give enough time to a patient's perspective.

She points to a study that says, on average, doctors wait only 11 seconds into a consultation before cutting a patient off with a close-ended question.

Increasingly, however, the medical profession is recognising that a patient's perspective is key not only to their experience, but to effective care.

A doctor and patient sit across from one another in an office, the patient with a blood pressure band around her arm.

Cheng currently works as a part-time GP at a student health service in inner-Melbourne. ( Supplied: Melanie Cheng )

"There's this whole discipline called narrative medicine, which recognises that illness unfolds through stories and that at the core of medicine is the patient's account of their illness and the clinician's ability to skilfully receive that story," Cheng says.

"The theory is that if you listen in an efficient way to the patient's story, you will reach the diagnosis much more quickly."

When she was involved in training registrars, Cheng and her colleagues asked that the doctors-in-training not cut a patient off for two minutes.

"They found it excruciating, because two minutes seems like a long time to listen to the patient's story when it's a 15-minute consultation," she says.

But the technique shifted the trainees' perspectives.

"I think most of the registrars appreciated that they got more information when the patient was allowed to tell the illness in their words, than they did from trying to nut it down to clinical symptoms," she says.

"It gives it much greater and richer context to the disease."

Dr Koppe says that humanistic approaches to medicine are getting greater traction in Australia's tertiary institutions — but that the university sector's increasingly mercantile approach to education is impeding this progress.

"The [mostly] financial pressures to train the largest number of people, in the shortest possible time, with the least expense … the opportunities for really deeper transformational learning, which is what's required for these kinds of things to happen, in fact become less," he says.

A clearer perspective

In Macca, the third story in Cheng's Australia Day, Dr Garrett — described as an "idealistic registrar" — struggles to help an older patient (Macca) with an alcohol addiction.

While Cheng's stories are "always fictionalised accounts", Dr Garrett's experiences do mirror her own.

"The patient did quite well for a time, but then they fell off the wagon, as often happens, and … as a junior doctor, I took that to be a real failure on my part," she says.

"I'd had such great hopes of changing this person's life through my consultation."

It wasn't until she sat down to write a story about her experiences that Cheng had a realisation.

"I was making this patient's recovery someway about me and how good I was as a doctor," she says.

Now she takes a longer perspective on the patient-doctor relationships.

"You're with these patients over a long period of time, and you can't see these episodes of care as being what's going to change the trajectory of their lives forever. It's about actually being there in the long term," she says.

"The writing of that story that helped me to understand that, and to understand where the patient was coming from."

Room for a Stranger and Australia Day are published by Text.

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Why Health Care Professionals Should Write

There are a lot of good reasons to learn to write well. But is it really worth it for doctors and nurses – already focused on a challenging field and stretched for time – to learn the craft? Many nursing and medical schools say yes, but their reasons might surprise you.

Dr. Jason Schiffman, editor-in-chief of Anxiety.org, told Career GPS in September that doctors have a responsibility to help patients find good information on the Internet, which means they need to become curators and content creators. But for several writing programs housed in nursing and medical schools, the reason for health care professionals to write is not actually about publishing. The programs are interested in the benefits of the act of writing itself.

"Writing makes people better doctors because it increases their ability to be good observers," Reisman said. "They start to pay attention to details. If they're writing about a patient, we encourage them to notice not only what the patient looks like, but ask, what are the sounds around the patient? What are the smells in the patient's room?"

These skills help doctors notice more things about their patients, which helps boost empathy and diagnostic ability.

"Learning the craft of writing requires that you learn how to reflect the perspective of others," Reisman said. "That's obviously a huge part of being a doctor."

Nellie Hermann, chief writing faculty in the Narrative Medicine program at Columbia University Medical School, said giving students and faculty the tools of reading, writing and understanding stories is an important part of their program.

"In any field where a person is asked to interact with lots of other people, learning how to understand stories is inevitably a crucial part of the work," Hermann wrote in an email.

James Stubenrauch, Senior Fellow at the Center for Health, Media and Policy at Hunter College in the City University of New York (CUNY), co-taught the first narrative writing course to students in the Hunter-Bellevue School of Nursing. Developing a daily writing practice, he said, helps nurses combat the burnout, exhaustion, fatigue and stress that comes with dealing with death and suffering. It also empowers them to speak up and take greater roles in decision-making.

"It's part of a self-care strategy as well as making a better provider out of whoever does this kind of work," he told Career GPS . "What I'm trying to do in this course is give people permission to get their own voices in the room and down on paper."

Stubenrauch's writing course for nurses will continue in the spring if funding comes through. He plans to add a blogging component to the curriculum.

But health care professionals should not necessarily jump straight to blogging or publishing, though many Yale residents have published their work . Instead, Reisman advises her students to begin writing by keeping a journal. It's a low-pressure way to not just record events but to revisit observations and emotions later on.

"For me personally, writing has been a way to understand myself and to think through experiences," Reisman explained. "If I'm writing an essay about an experience, trying to get it right forces me to really look at it deeply in a way that I might not do if I'm just running through it in my head. And when we're teaching residents, they start to understand that also."

Read more about health care professionals who write and writing skills:

Don't be afraid of HIPAA, say nurse bloggers

Should Doctors be the New Curators of Medical Information?

Back to Basics: Lifelong Writing

Photo credit: "Writing" by Jonathan Reyes in Flickr Creative Commons

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First drafts: Why healthcare professionals should study creative writing

by Jay Baruch, MD

For every voice crying that medicine is lost, there are assertions that technology will come to our rescue. I’m both beguiled by where technology might take medicine and suspicious that our enchantment with it will ignore the foundation of the physician/patient interaction, which is so undeniably low-tech it’s been around for tens of thousands of years. If a Cro-Magnon man injured his leg hunting mammoths and visited Dr. Hairy Shoulders in the emergency cave, the basics of the care would be no different than what will run between me and my patients during my emergency department shift this evening. We will share stories.

In one of his books , the esteemed physician/writer Robert Coles said, “The people who come to see us bring us their stories. They hope they tell them well enough so that we understand the truth of their lives. They hope we know how to interpret their stories correctly. We have to remember that what we hear is their story.”

Medical educators and attending physicians dutifully encourage students and residents to attend to the patient’s story. This is well-intentioned advice that may inadvertently set up our physicians-in-training on a task that’s akin to chasing windmills. The stories patients tell me are rarely well-conceived buried treasures waiting to be discovered. In the narrative disaster zone of the emergency department, patients’ stories often feel like a first draft, and first drafts–for most of us–are typically raw and messy.

Patients’ stories are complicated, intensely personal and disorganized. Crafting cohesive narratives requires effort under the best of circumstances–a comfy chair, a steamy cup of coffee, a quiet room. But our patients come to us sick, frightened, tough and maybe distrusting. They face a daunting task that we sometimes take for granted: to construct deeply personal narratives for nurses and physicians who, until that moment, were complete strangers.

In my article, “ Creative Writing as a Medical Instrument ,” I propose that for healthcare professionals to become story experts, they must think creatively, through the mind’s eye of a writer. Studying the creative writing process by building stories from the ground up helps us become intimate and acutely sensitive to the elements of craft and story construction. Once we have fiddled with dialogue, backstory and point of view, we understand the many different choices that affect how a story is told. Developing stories offers first-hand experience that can help nurses and doctors understand the degree of difficulty and the stumbling that happens when patients tell their stories, as well as how feedback, editing and rewriting are instrumental to telling stories well.

In my paper, I point out that most of my patients have not been to medical school. Certain patients are over-writers–telling stories bulging with information, unsure which pieces might be relevant. They write large, and my work involves helping them edit down to their key concerns. Other patients feel like stoic minimalists. They can seem like difficult storytellers, bearing illness with a tough resolve, or guarding against a worrisome diagnosis by withholding revelatory details. These cases involve intuition and effort, suspecting and examining story gaps while simultaneously resisting the decision-making brain’s tendency to be satisfied with available information.

Healthcare professionals make decisions, including the appropriate use of technology, based on the stories patients share. It makes sense that healthcare providers should be story experts. Thinking more creatively makes us more accepting of challenging stories. By probing and questioning, we can ensure that the story we are hearing is the one our patients are trying to tell.

Story becomes the ground that patients and healthcare professionals travel together: an unpaved road, potholed and puddled, that often lacks signposts, that makes no great rescue promises. But it’s a meaningful journey where we will get muddy together.

Jay Baruch, MD is Associate Professor of Emergency Medicine at the Alpert Medical School at Brown University, where he serves as the director of the Program in Clinical Arts and Humanities and co-director of the medical humanities and bioethics scholarly concentration. He’s the author of the short fiction collection, Fourteen Stories: Doctors, Patients, and Other Strangers (Kent State University Press, 2007). What’s Left Out , his new collection of stories, is forthcoming from Kent State University Press in 2015.

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Through the Kaleidoscope: Creative Writing in Healthcare Education

Roshni beeharry, a medical educator and writing for wellbeing and personal development facilitator, reflects on the multitude of ways creative writing practice contributes to a well-rounded healthcare education..

In 2013, I formally explored the field of creative writing in healthcare education via a systematic review of international literature, the findings of which are discussed in my article “The potentials of creative writing in healthcare education” (Beeharry 2021, 53-5). I found that creative writing can not only facilitate staff and students’ professional development, including understanding and empathising with patients, but also help staff and students understand their own narratives and those of peers, which in turn can contribute to their wellbeing and personal development.

Reflecting on and building on my ideas since that review, I propose that creative writing in this context can be viewed through a ‘kaleidoscope’ of lenses:

Creative writing pedagogy including creative writing as a craft;
Therapeutic writing, in particular Pennebaker’s expressive writing paradigm (Pennebaker 1997);
Adult learning theories, including reflective practice, transformative learning and constructivist theories: for example I propose that the writing group could be considered a potential ‘zone of proximal development’, with the writing group peers and facilitator providing a ‘scaffold’ for development’ (Vygotsky 1978) and the writing workshop as a small group learning environment and potential interprofessional community of practice, as well as a form of simulation to explore personal and professional identity.

Having an insight into pedagogy allows us as educators not only to design new educational activities involving creative writing, including the assessment of them (a somewhat controversial area beyond the scope of this short article), but can also help us ‘stand our ground’ in the face of resistance and murmuring rhetoric by colleagues that the arts might be a ‘nice distraction’ or optional extra in healthcare education, but not something worth integrating or investing in, in increasingly-crammed curricula or cash-strapped health services.

Creative writing as craft vs. reflective writing model

Creative writing as a discipline has its roots in other pedagogy including composition studies and literary studies. In my systematic review, participants in groups from these disciplines produced (as a percentage of the final 26 articles analysed): prose including novels and short stories (67%), poetry (48%) and playwriting (19%). Although each have their own taught structures, there is flexibility and these structures become more implicit as the writer improves their craft. Compare this to one of the seminal models of reflective writing used across healthcare education, the Gibb’s Reflective Cycle model, which is specifically structured: Description of event – feelings – evaluation – analysis – conclusion – action plan (Gibbs 1988). This is explicit in format, factual and certainly not imaginative in nature. For me, the creating and building up of a story, a poem or other form of imaginative writing is a refreshing antithesis to the analytical deconstructive process of academic writing and reflective practice models. Instead, under a craft-based pedagogy, healthcare clinicians/student-writers give themselves permission to experiment and play, and to potentially discover aspects of themselves, their patients and wider society, through the process of writing.

In healthcare education, the aim of reflection is of course to improve one’s practice through practical behavioural change, and to enhance professional development . Although creative writing can be a form of reflective practice, it is important to distinguish the two, and to be mindful that there may sometimes be a blurring of the two areas in healthcare literature, as I found in my systematic review. An excellent resource is Lisa Kerr’s paper on creative writing as reflective practice in healthcare education, which gives a comprehensive appraisal of this area at the time of writing (Kerr 2010).

In both expressive and reflective writing, the process is fundamental, more so than the final product (although reflective essays, for better or worse, are often assessed in medical undergraduate education at all levels). In creative writing, the outcome or ‘product’ – the poem, prose or other piece – is the focus, existing for others to consume. However, neither reflective writing nor expressive writing are considered a craft , something that can be developed, improved and honed with practice, revision and feedback from others. That is, no emphasis is placed upon developing our views, opinions, communication skills or insight, or upon reflection by doing the writing, sharing it and integrating feedback through revision, though this has much in common with academic writing processes. In educational terms, this can be seen as a form of praxis and experiential learning. Writing involves making choice s: what to include and what to leave out; using appropriate literary techniques such as metaphor, simile and imagery; tense and word choices; editing and revising. And where else does carefully choosing your words carry higher stakes than when communicating life-changing news to a patient, or persuading colleagues of a new research or educational idea?

Celia Hunt and Fiona Sampson suggest that:

Fictionalizing from ourselves and finding a satisfactory form for our fictions helps us to engage more deeply with our inner life, opening up possibilities for greater insight and self-understanding (Hunt and Sampson 1998, 33).

Patient narratives are often not linear and do not always fit neatly into the categories of the ‘medical history-taking’ format, but can be complex and multifaceted, reflecting what is true for all of us: that life itself does not follow one straight path, but is complex, and we are multifaceted beings. Fiction, particularly storytelling techniques, allows us to experiment and play with linearity, possibilities, alternative perspectives and time. Part of developing as a healthcare professional, and as a maturing adult, is reflectively and reflexively examining our own narratives and life stories, and that involves retelling our own stories, what some refer to as ‘restructuring our own narratives’.

Experimenting with the point of view of characters in a poem or piece of prose – the intimacy of first and second person point of view versus the relatively distancing third person stance – can contribute to the development of empathy and reflection in different ways. Physician Jay Baruch expresses this eloquently:

By playing with words, students begin to figure out how cutting sentences can give words room to breathe. Sometimes less is more, and readers fill the space with their own interior landscape, rife with memories, emotions, biases and preconceptions. What we say to patients, and what they tell us, is more than information. The words we choose, and the voice in which they’re delivered, contain hints to our history, values, desires and character (Baruch 2013, 468).

The reading of poetry has increased during the pandemic , as it has at other times of turmoil (Jack 2021). What is it about poetic forms that makes them appealing for expressing the complexity of emotions we face in delivering and receiving healthcare? In my view and experience, poetry can distill emotions and experiences that are otherwise difficult to articulate. Like prose, poetry can convey meaning through imagery, metaphors and other poetic devices. Perhaps it is also the fact that there is no need to add narrative or linearity, but one can merely capture and communicate an essence of the experience, that makes poetry an attractive art form to healthcare professionals as well as writers.

The importance of the ‘flow state’

Creative writing as a flow activity is an area that I feel is overlooked in the health humanities literature. In his seminal article, psychologist Mihaly Csikszentmihalyi introduces us to his concept of flow, which can be achieved, he proposed, through engaging in creative, sporting and religious activities:

The concept describes a particular kind of experience that is so engrossing and enjoyable that it becomes autotelic, that is, worth doing for its own sake even though it may have no consequence outside itself… You lose your sense of time, you’re completely enraptured, you are completely caught up in what you’re doing, and you are sort of swayed by the possibilities you see in this work… (Czikszentmihalyi 1999, 824).

This is exactly why I have enjoyed creative writing since childhood; that absorption, getting lost in time and in a world I create.

Csikszentmihalyi goes on to say:

The idea is to be so, so saturated with it that there’s no future or past, it’s just an extended present in which you are… making meaning. And dismantling meaning and remaking it ( Csikszentmihalyi 1999, 825 ).

And isn’t making meaning of our lives and our experiences a key part of what defines us as human beings and brings us together (but also can drive us apart)? Sharing this supportively with peers and colleagues has the rich potential to foster recognition and ‘bonding’ through commonality of experience, building and nurturing communities of practice.

In a world where outcomes and assessment are a constant presence, it can be liberating to give yourself permission to create something new and imaginative, rather than purely factual, limited in its scope by virtue of truth. That is, giving yourself permission to play and have fun. Creating something from oneself – a poem, story, piece of memoir – can bring a sense of achievement and satisfaction as meaningful, for some of us more so, than any exam result.

About the author

Roshni Beeharry is a writer, poet, medical educator and Writing for Wellbeing & Personal Development Faciltiator, who designs and facilitates writing workshops for the public, staff and students in healthcare, academia and other organisations, and special study modules for medical students in Creative Writing for Personal & Professional Development. She is a former Consultant in Neurological Rehabilitation Medicine. Roshni is currently Teaching Fellow in Clinical Communication & Cultural Competence at Kings College School of Medicine, London.

Baruch, J.M. 2013. “Creative Writing as a Medical Instrument”. Journal of Medical Humanities 34, 459–69. https://pubmed.ncbi.nlm.nih.gov/24006190

Beeharry, Roshni. 2021. “The potential of creative writing in healthcare education”. Writing in Education 83, 54-5. https://www.nawe.co.uk/Private/133615/Live/attachment1/WiE%20Spring%202021%20online%20CONFERENCE.pdf

Csikszentmihalyi, M. 1999. “If we are so rich, why aren’t we happy?” American Psychologist 54 , no. 10, 821–2.

Gibbs, G. 1988. Learning by Doing: A Guide to Teaching and Learning Methods . Oxford: Oxford Further Education Unit.

Hunt, C. and Sampson, F. (eds). 1998. The Self on the Page: Theory and Practice of Creative Writing in Personal Development. London: Jessica Kingsley Publishing.

Jack, Belinda. 2021. “Pandemic reading: poetry, looking and seeing.” The Lancet 391, 1438-9 . https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00831-X/fulltext

Kerr, L. 2010. “More than Words: Applying the Discipline of Literary Creative Writing to the Practice of Reflective Writing in Health Care Education ” . Journal of Medical Humanities 31, 295–301. https://doi.org/10.1007/s10912-010-9120-6

Pennebaker, J. W. 1997. “Writing about emotional experiences as a therapeutic process”. Psychological Science 8, 162-6.

Vygotsky, L. S. 1978. Mind in Society : the Development of Higher Psychological Processes . Cambridge, MA: Harvard University Press.

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In-verse reflection: structured creative writing exercises to promote reflective learning in medical students

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Published: 20 May 2022
Volume 43 , pages 493–504, ( 2022 )

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David McLean 1 ,
Neville Chiavaroli ORCID: orcid.org/0000-0003-1488-9747 2 , 3 ,
Charlotte Denniston ORCID: orcid.org/0000-0002-3654-6721 3 &
Martin Richardson 1

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Medical educators recognize the value of reflection for medical students and the role creative writing can play in fostering this. However, direct creative writing tasks can be challenging for many students, particularly those with limited experience in the arts and humanities. An alternative strategy is to utilize an indirect approach, engaging students with structured tasks that obliquely encourage reflection. This paper reports one such approach. We refer to this approach as in-verse reflection , playing on both the structure of the writing and its novel approach to reflection. Students were invited to write, in verse-like structures, about their personal and clinical experiences as medical students. Thematic analysis of their creative outputs and reactions identified four principal themes: the challenges of life as a medical student, the emotional demands of the medical course, a sense of connectedness and solidarity with fellow students, and a sense of marginality within the hospital system. Students generally found the tasks highly engaging and conducive to reflection, producing texts representing significant insights into their experiences as medical students. The reported method offers a relatively simple, structured, and guided approach to reflective writing, adding to the repertoire of methods available to educators in the medical humanities.

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Introduction

Reflective writing is increasingly seen as an important educational practice in medical and health professional education to help achieve desired learning outcomes such as communication, empathy, and professionalism (Moniz et al. 2015 ). Medical educators may use a variety of writing tasks and forms to engage students and foster reflection, including focused essays, journal entries, and creative writing tasks (Green et al. 2016 ; Kerr 2010 ). While the potential value of reflective writing is widely acknowledged, unstructured approaches may be hampered by student reluctance or hesitation to engage or participate meaningfully (Aronson 2011 ; Sandars 2009 ). In particular, the individual free writing approach typical of many written exercises may not align with contemporary students’ preference for group-based and creative activities (Sandars 2009 ). On the other hand, tightly structured or focused reflective writing tasks, especially those that are summatively assessed, may be viewed cynically by students, who often aim to give teachers the responses they think educators are looking for (Belling 2011 ; Birden and Usherwood 2013 ).

In our second-year medical program, we initiated an approach to guide and promote student reflection of their clinical learning experiences, the implementation of which was feasible for educators and genuinely engaging for students. To do so, we drew on short and structured creative writing exercises with the aim of guiding and prompting students to think about their professional journeys and experiences. Our approach is based primarily on the first author’s educational practice of using such activities in English classes in a secondary school setting (McLean 2020 ). This approach has been relatively under-utilized in the creative writing practices currently employed and represented in medical education (Bolton 1999 ; Cowen et al. 2016 ; Kerr 2010 ; Morris 2001 ). As many educators have pointed out, explicit creative writing tasks can form barriers for students for several reasons, including the belief that they do not have the necessary writing skills, an unease about exercises that have no single correct response, or a discomfort with emotionally laden issues (Kerr 2010 ; Sandars 2009 ; Shapiro et al. 2009 ). This arguably applies even more so to poetic writing, where the ambiguity and fluidity of language and meaning can significantly deter students unfamiliar with the genre (Wellbery 2006 ). However, as Johanna Shapiro has shown in her book The Inner World of Medical Students ( 2009 ), there are numerous medical students who are (or become) very comfortable and proficient in reflecting through poetry and verse and who derive great benefit and meaning from engaging in this format. For them—and potentially their peers—the poetic form can be liberating and enabling.

Our approach aims to draw on the power of poetic form and ideas while attempting to address the challenges it can present to medical students. We generate short, simple, and structured tasks which, while not presented as poetry as such, do produce writing with a poetry-like structure. We refer to this method as in-verse reflection , playing on both the structure of the writing and its indirect approach to reflection. In this method, the focus is (seemingly) on the structured sequence of instructions rather than the creative process/product; the reflective component occurs almost incidentally, although no less significantly, through both the activity itself and the ensuing collaborative discussion. Through such seemingly trivial writing tasks, we engage students who are usually outcome-oriented and assessment-driven in creative and fun activities that can, nevertheless, lead to insightful and often quite profound writing and reflection. Essentially, we aim to awaken reflection in students instead of attempting to guarantee it through more direct and potentially constrained approaches (Saeverot 2022 ). It is, in some ways, a form of gentle misdirection—or, speaking more pedagogically, it uses indirection as a way of fostering reflection.

The use of indirect techniques and pedagogies has a strong base in both education and humanities disciplines, where indirection is defended as frequently desirable, if not necessary, to generate reflective insights and meanings that may be limited by direct communication or transmission of knowledge (Fraser 2020 ; Saeverot 2022 ). The theory of indirection is notably, and more popularly, represented in the book Drawing on the Right Side of the Brain by Betty Edwards ( 1979 ), which teaches drawing through the strategy of turning the figure upside down and forcing the brain to forego the assumptions and expectations of conventional orientation, bringing intuitive and spontaneous elements to the fore. The use of indirection is also not new in medical education. Both Bleakley ( 2015 , 146) and Belling ( 2011 ) report on the use of indirection in “art rounds” in medical contexts. As Belling explains, commenting on the research study of Gaufberg and Williams ( 2011 ), museum objects were used to promote reflection in medical students by focusing primarily on the art object itself rather than the transferable skills. While such skills-based approaches are not uncommon in the medical humanities (Blease 2016 ; Chiavaroli et al. 2018 ), they can come unstuck in the context of teaching for reflection. As Belling argues, “authentic personal responsiveness” is integral to reflection ( 2011 , 580), and overly didactic approaches to teaching it, even when using creative products, can inadvertently elicit superficial or even cynical responses. Furthermore, drawing inspiration from Emily Dickinson’s notion of telling the truth slant , some medical educators seek to use poetry’s natural affinity for indirection to enable students to produce experiential insights about their professional development (Gaufberg and Batalden 2007 ; Shapiro and Stein 2005 ). Such an approach, Shapiro and Stein write, “allows learners to more easily examine intangible aspects of their relational experiences in medical school. Issues that seem straightforward when organized through the well-defined and prescribed formulas of the case presentation yield other interpretations when explored in verse” ( 2005 , 279). In the study reported here, we sought to utilize these very advantages of verse writing and indirect reflection by using creative tasks that were more guided and structured than might typically be the case with poetry sessions.

The second year of the medical course marks the transition from a pre-clinical campus-based first year to clinically based learning for the graduate-entry Doctor of Medicine (MD). The Epworth Hospital is one of the smaller clinical schools of the Melbourne University Medical School, with approximately 15–20 students based at the hospital for their second-year clinical rotations (from a full second-year cohort of approximately 350 students). As such, there was an opportunity to engage with students in creative reflective exercises that may not have been possible in larger cohorts. Our aim was to enable reflection on clinical learning experiences through creative exercises and to balance the otherwise dominant science basis of the clinical curriculum while introducing students to alternative ways of knowing in medicine, such as those associated with the medical humanities (Chiavaroli et al. 2018 ; Jones et al. 2019 ). The cohort of second-year MD students from the Melbourne University Medical School based at the Epworth Hospital was invited to participate in four one-hour workshops. The workshops reported in this paper were conducted throughout the course of 2019. Ethics approval for the study was obtained from the Human Research Ethics Committee, Melbourne Medical School, University of Melbourne.

The workshops consisted of several writing tasks designed to stimulate creative responses about students’ clinical education experiences. They were not cumulative or sequential in orientation, though each provided an opportunity for students to take a more holistic view of their experience. Participation was entirely voluntary, and there was no assessment attached to the workshops. Sessions were scheduled during March, May, August, and October to coincide with the timing of different clinical rotations (namely, Foundation, General Medicine, Surgery, and Emergency Medicine). Table 1 below outlines the nature of the tasks used in each workshop.

At the completion of each session, students were invited to share with the group the writing they had produced. Not all students chose to do so, but the majority at each workshop did. Students were also asked to provide a few lines reflecting on the nature of the activity in which they had participated. These reflections were anonymously written and collected in such a way that would not identify students while still providing useful evaluative reflections about the activities for us as educators. Each workshop, therefore, produced both creative products and explicit reflections from each student on the activities by way of workshop outputs.

The authors analyzed the collected data for prevalence and significance, following the protocol for qualitative thematic analysis outlined by Braun and Clarke ( 2006 ). All authors read through the data independently, coding for significant ideas and collating relevant data into key themes, and then met to compare and discuss codes and resultant themes. All authors discussed and debated the allocation of codes and their merging into broader themes until agreement was reached on the main themes presented below (Table 3 ). Although analysis commenced at the end of the first task, results were not used to modify subsequent tasks, which had already been planned and developed.

Fifteen medical students from the 2019 cohort participated in at least one workshop; eight students attended two sessions, and four attended three sessions. No student attended all four sessions. In total, 51 discrete creative products were generated by the participating students. Sample creative pieces are shown in Table 2 below. These are presented here solely as examples of the kind of writing produced through each task rather than as representing any particular theme or quality.

Alongside the creative pieces, the students also provided 32 anonymous comments about their experiences in participating in the workshops. This provided evaluative data about the impact of the workshop, albeit at the level of student reactions only (Kirkpatrick 1996 ). Through the thematic analysis of students’ written products and reflections on the activities, we identified four key themes about students’ clinical learning experiences:

the challenges of life as a medical student;

the emotional demands of the medical course;

a sense of connectedness and solidarity (with fellow students); and

a sense of marginality (within the hospital system).

In addition to the above course-related themes, students’ evaluative comments on the nature of the creative activity itself were collated into a separate theme of Student Reactions. These themes are illustrated in Table 3 , with representative comments drawn from students’ evaluative comments. Again, these examples are intended as illustrative only.

For many medical educators with backgrounds in the humanities or a deep appreciation of the arts, the idea of using creative activities to help students write and reflect seems quite intuitive. This works well for the many medical students who have experience in such curricula and activities; for other students, however, the road to medical school has been paved with scientific textbooks and long hours of rote learning. Creative writing or reflection may not feel or come naturally in such a context. As many educators have noted (Kerr 2010 ; Sandars 2009 ; Shapiro et al. 2009 ), many students do not see themselves as writers or struggle to know what to write about in conventional reflection exercises. And, of course, the verse form itself is an unfamiliar and potentially intimidating genre for many medical students. In presenting the verse structure in such a structured and somewhat mechanical way, we encouraged and enabled our students to write and think quite differently from the objective, convergent ways more commonly utilized in the medical curriculum, aided by the apparent freedom of the indirect approach to reflection.

Despite some initial hesitation and uncertainty, students engaged positively and collaboratively with the activities. Part of this engagement is undoubtedly attributable to the voluntary nature of participation in the workshop, but the challenge and unfamiliarity posed by these tasks should not be underestimated. Both the nature of the activities and openness of the tasks were very different from the type of logico-deductive ways of thinking and factual scientific content that dominate the medical curriculum (Bleakley 2015 ), and several students noted this in their evaluative comments (e.g., “I have not approached reflection in this format before. … reflection does not have to be incredibly time consuming or daunting” [I19]). We believe the constrained and structured set of instructions provided important focus and guidance to the students (Aronson 2011 ), enabling them to overcome initial uncertainties and produce verse-like compositions that appeared to meaningfully represent their own clinical experiences while also resonating deeply with their peers. Many of the students’ verses were insightful and highly evocative; we would even say poetic , though this was not the point of the exercise.

From the students’ evaluative comments, it was clear that the commonality of their experiences and reactions evoked a strong sense of solidarity and relief, as others were experiencing similar feelings about the course and their sense of emerging professional identities. Many students mentioned the sense of camaraderie among the students during the exercise, and several comments related to the affective dimension of the exercise. As one student remarked: “The thought-provoking nature of these sessions has allowed me an opportunity to re-appreciate the exquisiteness of abstraction. I forgot how interesting things are” (B19). Many students reported that the tasks were actually fun —certainly more fun than they had anticipated—and something not necessarily associated with a medical course. Even those students who struggled somewhat with the indirectness of the tasks (e.g., students D19 and O19 in Table 3 ) still generally responded positively to the sessions.

We see other connections between the in-verse reflection approach and the broader project of the humanities in medical education, besides the use of indirection. The humanities continue to be a source of renewal and diverse pedagogies for medical curricula, being utilized in various ways and for different purposes. Initially, its primary role was to support the learning of clinical skills (Blease 2016 ), such as communication, empathy, and teamwork. Medical humanities scholars have extended this scope to more epistemological rationales that include clinical reasoning and personal identity formation (Bleakley 2015 ; Boudreau and Fuks 2015 ; Chiavaroli 2017 ; Moreno-Leguizamon et al. 2015 ) as a counterbalance to the dominant scientific and technological foundation of medical practice (Montgomery 2006 ; Whitehead 2013 ). We see the in-verse reflection approach as applicable to both instrumental and epistemological orientations depending on the emphasis placed on the activities as either a means of facilitating reflection or a broader way of prompting students to think differently about their clinical learning experiences.

Another connection with pedagogical practice in the humanities is the notion of “playful learning,” a relatively well-utilized pedagogy in school contexts (Kangas et al. 2017 ; Mardell et al. 2019 , 232) and one that is emerging in higher education (Forbes 2021 ), especially in the humanities disciplines (Jensen et al. 2022 ). We had certainly hoped that our students would find the activities fun, but we were surprised at the number of comments that reflected enjoyment even alongside confusion or bewilderment. Some students even appreciated the humor inherent in the approach (e.g., “Adding humor is therapeutic in reflection and allowed me to overcome thoughts and experiences that were previously avoided or swept under the rug” [F19]). Of course, ours is not the only method to draw on this element of humanities pedagogy; a similar underlying spirit can also be seen in the successful use of comics and other creative practices in medical education (Green 2013 ; Shapiro et al. 2021 ; Maatman et al. 2021 ). Such playful learning can be a valuable counter to the typical emphasis on the “logics of efficiency, competition and achievement” (Jensen et al. 2022 , 206) that can characterize many medical courses, while other research suggests that play promotes learning and engagement and helps create relational safety and positive affect and motivation (Forbes 2021 ). Jensen et al. ( 2022 ) go further to draw more direct links with humanities pedagogies:

Addressing teaching activities as playful relates to broader aspects of humanities in higher education that aim to support the students’ development of judgment and active engagement in learning; of their individual, professional and social identity; and of meaningful life choices within and beyond their education. (199)

These are exactly the kind of broad epistemological perspectives and cognitive skills we want our medical students to acquire, alongside the necessary and obviously important scientific and clinical knowledge required for good medical practice. The in-verse reflection method appears to tap into this vein of playful learning, providing an adaptable and useful framework for incorporating such an approach into medical education. Even with the relatively limited sessions and non-compulsory participation, the mix of serious insight with lighthearted and occasionally wry sentiments is a marked feature of the students’ outputs.

Nonetheless, we recognize that many students may find the indirect and playful nature of the tasks potentially irrelevant or even disconcerting. While this can be a useful source of “creative tension” in reflective activities (Wald 2015 , 702), it may also point to the challenges of trying to balance an entire science-focused curriculum with a few short voluntary creative sessions. As educators, we certainly need to acknowledge and respect that not all students will warm to such activities, but our results encourage us that most students are prepared to give it a genuine try. Ultimately, though, we see the in-verse approach as an additional method for engaging students in reflective practice to be used alongside more direct and conventional approaches to facilitate reflection in medical students.

Several other limitations of this study are also acknowledged. The number of participants was relatively small and limited to a single clinical learning site. The site itself may also limit generalizability in the sense that, as the most recently instituted clinical school of the MD program, there may well be an openness to innovative approaches that may not be easily adopted at larger, more well-established clinical schools. The evaluation component of the workshops, of course, only gathered immediate responses, and further systematic follow-up is planned. Finally, we did not attempt to compare our approach with more conventional, direct methods for reflection, which could be expected to yield useful insights. Our primary aim in attempting this novel and alternative approach was to encourage busy and assessment-focused medical students to take time out from their clinical schedule and, through fun, collaborative, and relatively efficient creative activities, explore the potential of reflective practice in all its guises. We believe our findings, however early and provisional, offer considerable promise when it comes to the value of such indirect and playful approaches to reflection through writing. To be able to generate such profound and relatable themes in a few sessions with very brief writing tasks was a significant outcome.

The in-verse reflection approach appears to offer a feasible and stimulating opportunity to engage students with reflection about their learning while providing a sense of connectedness and an invaluable opportunity to share and discuss their clinical experiences and the process of professional identity formation. It does so through short, enjoyable, and structured creative exercises. The highly relevant and insightful nature of the creative outputs produced by the students point to the potential value of indirectness and playfulness when utilizing humanities approaches in medical education contexts. The described method adds to the repertoire of techniques to facilitate genuine reflection in medical students and can potentially assist medical schools in finding the necessary space in the curriculum for such activities.

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We thank the anonymous reviewers for their thoughtful and constructive comments on earlier versions of this manuscript.

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DM and MR conceived and implemented the method described in this paper. NC and CD supported the educational application of the approach and its theoretical framework. The collected data were jointly analyzed and interpreted by all authors. The paper was drafted by DM and NC and revised critically by all authors for intellectual content. NC and DM completed the final draft. All authors approved the final version of the manuscript.

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McLean, D., Chiavaroli, N., Denniston, C. et al. In-verse reflection: structured creative writing exercises to promote reflective learning in medical students. J Med Humanit 43 , 493–504 (2022). https://doi.org/10.1007/s10912-022-09740-7

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Narrative Medicine: Every Patient Has a Story

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Reflective writing also provides a “safe space” for students to discuss the stresses of medical school and their professional fears, she added.

Jake Measom, a fourth-year medical student at UNR, said that participating in the narrative medicine scholarly concentration has pushed him to be more creative in his approach to patient care. He also sees narrative medicine as a “remedy to burnout,” noting that while the practice of medicine can sometimes feel monotonous, narrative medicine reminds him that “there’s a story to be had everywhere.”

“It not only makes me a better physician in the sense of being able to listen better and be more compassionate,” he said, “it also helps you gain a better understanding of who you are as a person.”

Storytelling as a means of coping

“ First you get your coat. I don’t care if you don’t remember where you left it, you find it. If there was a lot of blood, you ask someone to go quickly to the basement to get you a new set of scrubs. You put on your coat and you go into the bathroom. You look in the mirror and you say it. You use the mother’s name and you use her child’s name. You may not adjust this part in any way.”

That’s an excerpt from “How to Tell a Mother Her Child Is Dead,” which was published last September in the New York Times in the Sunday Review Opinion section. Authored by Naomi Rosenberg, MD, a physician at Temple University Hospital, the piece is a heart-wrenching example of how narrative medicine can serve as an outlet for coping with the harrowing experiences that providers regularly encounter.

Pulitzer Prize-winning journalist Michael Vitez encouraged Rosenberg to submit the piece in his new role as director of narrative medicine at Temple University Lewis Katz School of Medicine. After retiring from a 30-year career as a reporter at the Philadelphia Inquirer , Vitez approached the school’s dean about using his skills to help students, faculty, and patients translate their experiences into words. The idea morphed into Temple’s new Narrative Medicine Program, which launched in 2016.

Currently, the Temple program is fairly unstructured, with students and faculty working one-on-one with Vitez on their narrative pieces. For example, Vitez said a third-year medical student recently sent him a poem she wrote after an especially difficult day in her psychiatric rotation: “It helped her process her emotions and turn a really bad day into something really valuable,” he noted. Eventually, Temple hopes to offer a certificate and master’s degree in narrative medicine.

“I believe that stories have an incredible power,” said Vitez. “Understanding what a good story is and learning how to interview and ask questions will help you connect with your patients, understand them, and build relationships with them.”

Jay Baruch, MD, associate professor of emergency medicine at Brown’s Warren Alpert Medical School and faculty advisor to the narrative medicine course there, likewise maintains that the type of creative thinking often associated with the arts and humanities—and that narrative medicine often promotes—deserves a more central role in medical education.

“[Students and physicians] need to know the anatomy of a patient’s story just as much as the anatomy of the human body,” he said.

Health Care
Medical Schools

Course Syllabus

Narrative Medicine

Complete syllabus.

This class will guide all types of medical professionals (doctors, nurses, researchers, aides, social workers, etc.) through the various skills needed to write and publish narratives—personal stories of their experiences in health care (and those of others in the field). We will cover every step in the writing process, from brainstorming to researching to writing to revising as well as the steps needed to pitch and publish an article or essay. Our instructors—experienced writers of health care narratives and creative nonfiction—will communicate with participants through a combination of written lectures, written feedback, and email. In addition, the class will include phone conferences with guest lecturers Theresa Brown and Manoj Jain.

How it works:

Each week provides:

discussions of assigned readings and other general writing topics with peers and the instructor
written lectures and a selection of readings

Some weeks also include:

writing prompts and/or assignments
opportunities to submit a full-length essay or essays for instructor and/or peer review (up to 4,000 words)

To create a better classroom experience for all, you are required to participate weekly to receive instructor feedback on your work.

Enroll Now >>

Week 1: What is creative nonfiction?    This week we’ll explore the basic questions that drive this genre of writing: What is creative nonfiction? What are medical narratives, and why do we need them? Hospitals and medical schools around the world are beginning to recognize the power of narrative to inform, motivate, and teach. Every medical study has its own story. How do we find the difference between the story and the study? How do we make this story into a compelling piece of writing? Students will jump right into writing with a quick 500-word assignment.

Week 2: Reading like a writer    Most writers read for pleasure a great deal, and medical professionals read to keep current on the latest advances in medicine. But reading like a writer is a different skill, one that will allow you to take a piece of creative writing and understand how the author constructed it, then apply that knowledge to your own work. During this week we’ll dissect two different types of medical narratives: short pieces, such as might be found in a national newspaper, and longer, more involved narratives such as those featured in Creative Nonfiction, The New Yorker, and other long-format magazines. Participants will learn the basic structure and components of these articles and how to weave them together.

Week 3: Shaping your narrative   You may not know how to take the experiences from your career that have affected you deeply and shape them into a defined narrative—a story or plot that drives your writing and keeps a reader’s interest. A good narrative must be more than a series of facts, and even more than an interesting series of events; it must encapsulate some larger idea or meaning that will move the reader to emote, think, and act. The materials from this week will guide participants in next week's assignment to turn one or more personal experiences into a narrative piece of writing.

Week 4: The people at the heart of the narrative   Medical narratives are usually first and foremost stories about people, so helping your readers to care about the people in your writing is an important element of creating an effective narrative. During this week we’ll discuss writing techniques to help portray the complexity and humanity of the subjects in your writing. During this week participants will also submit their second assignment, a newspaper article or essay of 1,000-2,000 words, to the instructor and classmates for review.

Week 5: Incorporating Research   While you want your writing to have a strong narrative drive, you’ll also want to make use of your expertise and include medical, scientific, and/or professional information in this larger narrative structure. This week we’ll talk about how to incorporate scientific studies, statistics, scholarly quotes, and your personal knowledge into your narrative writing. We’ll also discuss how to find additional information through research, either by contacting expert sources or by looking for reliable information on the internet.

Week 6: Using detail effectively  Using specific and evocative detail is the key to creating a narrative that feels “real” to the reader, and that therefore holds the reader’s interest. During this week we’ll discuss how to use detail to create more convincing and moving writing. We will also explore ways to describe the more technical processes of the medical world in layman’s terms.

Week 7: Ethical and legal concerns   Ethical concerns about accuracy, privacy, and bias apply to all creative nonfiction writers, but are particularly important in medical writing where patients’ rights are a special concern. In this class we’ll review HIPAA and other legal guidelines for writing about patients and clients. We’ll also discuss some of the common ethical quandaries that arise when writing about other people and various ways to present the lives of these people in your writing.

Week 8: Your writing and revision process The process of taking a piece of writing from initial inspiration through drafts to a finished product differs for each writer. This week we’ll discuss some approaches to brainstorming, drafting, and revising that will help participants craft a plan for their own best practices. We will also briefly discuss how to work with an editor after you’ve created a polished draft. Participants will submit a revision of either of their previous assignments.

Week 9: How to write in medicine without losing your job Sometimes we as writers feel bold as we put our initial thoughts down on paper, but lose courage when it comes time to share or publish a piece. In this class we’ll focus on methods for writers who need to feel more comfortable with publicizing their opinions. We’ll also consider ways to write about controversial subjects without infuriating your opposition or jeopardizing your professional integrity.

Week 10: Pitching, publishing, and marketing your work   Taking the first step toward publication can be intimidating, so during this week we’ll tackle that challenge as a group. The class materials will discuss how to write a formal pitch for a nonfiction piece that can be submitted to an editor, and then how and where to send those pitches. We will also discuss steps for building a presence as a writer and marketing and publishing your work, through traditional print media as well as websites, blogs, and other methods. Each student will write a pitch that can be submitted to an editor for consideration at the end of the week.

ABOUT THE INSTRUCTORS

Ellen Ficklen is a career writer and editor who has held a number of editorial positions in the Washington, D.C., area and been widely published. Her articles have appeared in the Washington Post, the New York Times, USA Weekend, the Baltimore Sun, the Los Angeles Times, the Chronicle of Higher Education, Saveur, and Preservation. Ellen also has produced editorial projects for the National Geographic Society, American Rivers, NASA, and National Public Radio. She was the author of a "My Turn" column in Newsweek and a finalist for a National Magazine Award. Ellen is a coeditor of Narrative Matters: The Power of Personal Essay in Health Policy, published by Johns Hopkins University Press. For eight years, she was the editor of "Narrative Matters," the first-person essay section of Health Affairs, the nation's leading health policy journal, where she also was a senior editor of the journal. She has a B.A. from Connecticut College and an M.A. in writing (nonfiction) from Johns Hopkins University.

Guest Lecturers

Manoj Jain , MD MPH is an infectious disease physician, a writer, and a national leader in healthcare quality improvement. Dr. Jain writes regularly for the Washington Post, and the Commercial Appeal (Memphis newspaper). His writings also appear in the New York Times and the Times of India. He received his engineering, doctorate, and public health degree from Boston University. He has served as a consultant to the World Bank on HIV, and has been interviewed by CNN, and National Public Radio. Over the past 15 years Dr. Jain has given over a 150 talks, and published numerous scientific articles, chapters and books.

Theresa Brown , RN, is the author of Critical Care: A New Nurse Faces Death, Life, and Everything in Between (HarperStudio, 2010). She received her BSN from the University of Pittsburgh and a PhD in English from the University of Chicago. Brown is a regular contributor to the New York Times blog “Well.” Her essay “Perhaps Death is Proud; More Reason to Savor Life” is included in Best American Science Writing 2009 and Best American Medical Writing 2009. Theresa is a Board Member of the Center for Health Media and Policy at the Bellevue School of Nursing at Hunter College. She is also an Advisory Board Member for Scrubs Magazine, which won the 2010 Maggie Award for Best New Publication from the Western Publishing Association.

Past Guest Lecturers

Sayantani DasGupta , MD, MPH is an assistant clinical professor of pediatrics and a core faculty member of the Program in Narrative Medicine at Columbia University. She also teaches in the graduate program in Health Advocacy at Sarah Lawrence College, and is a prose faculty member in the summer writing conference Writing the Medical Experience at Sarah Lawrence College. Dr. DasGupta is author of Her Own Medicine: A Woman's Journey from Student to Doctor (1999), and co-editor of Stories of Illness and Healing: Women Write Their Bodies (2007). Her work has appeared in journals including The Lancet, JAMA, and The Journal of Medical Humanities, and her essay “Intern” is included in the anthology Becoming a Doctor. She is an associate editor of the journal Literature and Medicine.

Jason T. Lewis directs the Writing and Humanities program at the University of Iowa’s Carver College of Medicine. He is the managing editor of the university’s medical narrative publication, the Examined Life Journal, and the author of the novel The Fourteenth Colony. Lewis is a graduate of the Iowa Writers’ Workshop.

Enroll Now >>

Questions check out our faq page, or contact sharla yates at yates[at]creativenonfiction.org..

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Stanford University School of Medicine blog

How writing helps medical students and doctors handle stress

Poems about the spleen and tales from the operating room are what Laurel Braitman , PhD, expected to see when she started teaching medical students storytelling five years ago in her role as writer-in-residence for Stanford's Medicine & the Muse .

Her students did pen pieces about the usual medical maladies; but peppered among the submissions, she saw something else that gave her pause -- candid and raw descriptions of anxiety, imposter syndrome and even thoughts of self-harm.

Understanding the challenges

Researching the stresses faced by health care workers, Braitman learned that the feelings of depression, anxiety and hopelessness that some of her students wrote about weren't ephemeral, atypical, or something they'd "grow out of" once they became doctors. But the more opportunities she gave medical students to tell stories about their frustrations, joys and fears, the better the students reported feeling about themselves and their medical careers, Braitman explains in her new TED talk .

"I actually never decided to teach writing to students and faculty as a way of processing their emotions and experiences -- it just happened that way," Braitman told me in an email.

Discovering the benefits

She began teaching for Stanford Medicine & the Muse in 2015, leading storytelling workshops for medical students and for the broader Stanford medical community . Two years later, Braitman joined Stanford's department of anesthesia as faculty and became Stanford Medicine & the Muse's director of writing and storytelling. In addition to teaching and mentoring, she also co-founded a live storytelling series for medical students called TalkRx with medical student Pablo Romano.

One of Braitman's students, Lauren Joseph, wrote about her experience at a Medicine & the Muse storytelling retreat in a Scope story entitled, " I will not be a Robot Doctor ":

Students read pieces about times they failed miserably, times they were hurt, and time they will never get back again. ... As I sat there among all of these blessedly wonderful people, I felt their compassion and humility. They were, like me, struggling against the emotional drains of medicine, and yet they managed to elude the pressures that can harden us into becoming Robot Doctors.

The science behind storytelling

Quantifying how much writing can help medical students isn't easy or an exact science; but Candace Kim, an MD-PhD student at Stanford who works with Braitman, is making progress towards this goal.

Since 2017, Kim has conducted surveys of medical students who attend Medicine & the Muse writing workshops. She asks students to rank their distress from low ("0") to maximum distress ("7") using the Mayo Medical Student Well-Being Index , a measure that was co-developed by Tait Shanafelt , MD, Stanford's chief wellness officer.

Data from three workshops spanning 2018-19 suggest the workshops were helpful. Kim found that student distress scores decreased by about 43% from before the workshop to one week after it ended. One month after the workshop, students still reported feeling less distress, but the benefit had waned.

"I really think that doctors have the most important job," Braitman said, "and if their lives are at stake, so are ours."

This is especially true today as the coronavirus pandemic poses new and potentially life-threatening challenges for health care workers.

Combatting the stress of COVID-19

After the COVID-19 outbreak began, Braitman created a new course (available via Zoom and phone), called Writing Medicine . It's open to health care workers and their loved ones, and requires no writing experience or Stanford affiliation.

In this and other writing courses, students learn to be vulnerable, she said. Many rediscover what drew them to medicine in the first place, by sharing their stories, essays and other creative work.

More than 1,000 doctors, trauma nurses, respiratory therapists and other health care workers and their loved ones have participated in the Writing Medicine course. On Saturday mornings, they come together online to "pause, reflect, be creative and share," Braitman said.

Some members of this "virtual medical family" -- who hail from around the globe -- have already published their work. Others write purely for themselves, as a way to help process their experience.

Helping health care professionals express and communicate their feelings won't solve the problem of physician burnout, Braitman explained. But, she said, it is essential "in making sure our healers are healthy enough to heal the rest of us."

Images courtesy of Laurel Braitman and Ted Talks.

I’m a graduating medical student. This is why I write.

“I will not become a Robot Doctor”: A medical student vows to practice compassion

Padded helmet cover shows little protection for football players

Addictive potential of social media, explained

Write it off: Physician Writers Group helps doctors process stress, get creative

Physician Writers Group founder Kimberly Myers and Dr. Eileen Moser look at Dr. Jose Stoute as he presents an original work during a workshop in February. They are seated at a table with papers and laptops on it. Myers has short brown hair and glasses and is wearing a blazer with a turtleneck shirt and a scarf tied loosely around her neck. Moser, who wears glasses, smiles broadly at Stoute, who is gesturing with his hand. His face is not shown. A clock is on the wall behind them.

After a long day seeing patients at the hospital, Dr. Ian Ross unwinds by letting his thoughts and feelings run wild across a page – releasing all the stress of the day into a safe space.

“It’s almost become a therapeutic process for me – it helps me to process how I feel about things,” said Ross, an internal medicine hospitalist with Penn State Health Milton S. Hershey Medical Center . “Doing patient care 100% of the time can make you feel drained. Writing absolutely revitalizes me.”

Before medical school, Ross’s hobbies included music, sketching and acting – outlets for his creative energy that he really misses as a doctor. When he arrived at the Milton S. Hershey Medical Center last summer, he heard about Penn State Health Physician Writers Group and was immediately intrigued.

Kimberly Myers , who holds a doctorate in literature and is a professor of humanities and medicine at Penn State College of Medicine , began the group as a way for doctors to pursue creative writing for publication in scholarly journals.

At twice-monthly meetings, Myers discusses the literary elements of different genres – anything from poetry to personal reflection essays – and then participants write an original work and send it to their colleagues for review before the group meets again for critiques. They revise their work and, at the end of five meetings, have a portfolio of pieces to submit for publication.

The closeup faces of Dr. Nitasa Sahu and Dr. Samer Muallem reveal their intense concentration as Dr. Ajay Soni shares his original piece of writing. Sahu has long dark hair, parted on the side that is pulled back into a ponytail, and she wears a black sweater over a polka-dotted shirt. Muallem, who is wearing a sweater and has brown curly hair and a beard and mustache, holds a thumb to his mouth as he listens. Soni has short dark hair and has his mouth open as he reads.

From left, Dr. Nitasa Sahu and Dr. Samer Muallem concentrate as Dr. Ajay Soni shares his original piece of writing.

More than two dozen doctors have participated in the groups and published more than 40 pieces collectively in impressive places such as Journal of the American Medicine Association, New England Journal of Medicine, Annals of Internal Medicine, Journal of Clinical Oncology and other general and specialty medical publications.

“It’s very gratifying to see these doctors, who have accomplished phenomenal things in the medical field, become excited about publishing creative work on their experiences with patients and their own inner lives,” Myers said. “They find a sense of fulfillment and accomplishment in a domain they never expected.”

Being part of the group allows doctors to tap into another dimension of their personality – the human side – that can benefit not only themselves but their patients, said Dr. Joseph Gascho , cardiologist at Penn State Heart and Vascular Institute , prolific poet and member of the first Physician Writers Group.

“We can sometimes be too clinical, too scientific, and part of that is self-preservation, but the humanities – learning to listen and take in – is so important and helps you to understand people,” he said. “There is so much more to medicine than science – the older I get, the more I realize that.”

Gascho, who has had some 50 poems and prose pieces published in medical journals and whose first book of original poetry came out in 2017, said poetry gets at the ambiguities of medicine and helps him process on paper the gray areas for which he never finds answers in the exam room.

“It’s a way that I wrestle with things,” he said. “I like the terseness of expression with poetry, the way you can distill down the essence of things to an ‘aha’ way of thinking.”

The New Jersey-based Arnold P. Gold Foundation, which champions the human connection in health care, collaborated with the Physician Writers Group to produce a webinar. Penn State College of Medicine is a member of the Gold Partners Council, a group of medical schools and health systems that are leaders of humanism in health care and actively support the Gold Foundation’s mission. “The Gold Foundation is interested in highlighting innovative, impressive examples of engagement in humanistic practices by members of the Gold Partners Council, and Gold staff identified the Penn State Physician Writers Group as a perfect example,” said Pia Pyne Miller, senior director of strategy and business development for the Gold Foundation.

The foundation plans to distribute the webinar through its website, social media and the Gold Partners Council network, making it a resource for other humanistic institutions.

In the webinar, Myers gives an overview of the group, and 13 physicians share their writing.

Ross, who joined the Physician Writers Group last year, wrote about something he knew well – the loss of his creative side as he concentrated on becoming a physician. The words came easily, but when it came time to share it, courage did not.

“It was deeply, deeply personal – and I didn’t know if it was any good either,” Ross said with a chuckle. “Kimberly was so supportive and gave me great feedback on ways to improve.” It was that piece Ross read for the webinar audience.

Doctors who have participated in Physician Writers Group cohorts, many of whom continue to share their works with Myers and each other, credit her for inspiring them and ultimately making them better doctors.

Dr. Eileen Moser, Dr. Jose Stoute, Dr. Nitasa Sahu and Dr. Samer Muallem sit around a wooden table in a conference room as Kimberly Myers, her back to the camera, begins a Writers Group workshop. Moser is wearing a shirt, cardigan and printed scarf and has glasses and short hair. Stoute, who wears glasses, has short brown hair and is wearing a gray fleece jacket over a plaid shirt, is smiling. Sahu, dressed in a black cardigan sweater and a polka-dotted shirt, leans forward to listen. Muallem, who has short brown hair and a beard and moustache and is wearing a sweater, looks down at the table. Myers is wearing a blazar and has short brown hair. Bookcases, windows and a screen with a slide projected on it are in the background.

From left, Dr. Eileen Moser, Dr. Jose Stoute, Dr. Nitasa Sahu and Dr. Samer Muallem look on as Kimberly Myers, her back to the camera, begins a Physician Writers Group workshop.

Dr. Thomas Ma , chair of the College of Medicine’s Department of Medicine, believes in the therapeutic value of creativity so much that his department funds part of Myers’ time to facilitate the group.

“One of the top issues physicians face is burnout. It’s never been higher, with 60 percent of physicians nationwide exhibiting symptoms such as not wanting to go to work, depression, lack of engagement, substance abuse and ultimately leaving the profession early,” Ma said. Penn State Health’s internal research shows that its physicians align with these national trends. Ma’s goal is to cut the rate here by half, he said.

The Physician Writers Group allows reflective thinking, which has a positive impact on emotions and well-being, Ma said.

“I also think it helps them become more patient-centric and see a bigger picture that they may have forgotten because they are so wrapped up in day-to-day demands,” he said. “Any opportunity for me to help physicians use their creativity is a huge positive for our department, the college and the individual.”

See the Webinar

Watch the webinar here

The Joy of Medicine

This poem, by Dr. Joseph Gascho, was named Poem of the Year in 2014 by the Annals of Internal Medicine.

It’s about the man who pilgrimages to Talladega every October because you stented his widow maker and the couple celebrating their 60th who asked everybody to stand up and clap when you walked in to the VFW hall and the time you were in the shower and you thought about what the wordy lady told you in the office the day before and you ordered the blood test and prescribed the right pill and all was well and it would not have been

and looking back now believe it or not it’s answering the stat page at the Little League game in the bottom of the 5th right before Maggie hit the ball to right field and slid into third with a triple and leaving the warm bed with the candles burning to speed to the ED to sew up the drunk’s aorta and when you got home she was sleeping

but most of all it is about the long haul trucker who runs to Reno twice a week who doesn’t know he should be dead but you do.

Dr. Ajay Soni and Kimberly Myers sit at a table with bookshelves and drawn window shades in the background. Soni wears a white shirt and plaid tie and has short graying hair. He is looking down. Myers, who has short brown hair and glasses and is dressed in a blazer and scarf, is seated next to Soni. She gestures with her hand to make a point to the person seated next to her, who is not show. An open laptop sits on the table with a Word document open that shows several paragraphs.

Dr. Ajay Soni, left, considers Kimberly Myers’ editing suggestions.

If you're having trouble accessing this content, or would like it in another format, please email the Penn State College of Medicine web department .

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Creative writing workshops for medical education: learning from a pilot study with hospital staff

Affiliation.

1 School of Clinical Medicine, University of Cambridge; Cambridge, UK.
PMID: 23671146
DOI: 10.1136/mh.28.2.102

A course in creative writing was designed as a possible tool in medical education. Twelve volunteers (six doctors and six non-medical staff) participated in seven workshops held weekly. Four aims were identified: to help put thoughts onto paper; to facilitate interpretation of narrative; to encourage expression of emotions related to illness and death, and to encourage creativity. The course was evaluated using participant observational analysis and two questionnaires. This paper discusses the outcomes in relation to these aims, but identifies additional issues raised by the development.Only six of the 12 participants produced a final piece of written work, with lack of self discipline being cited as the chief reason. There was a strong tendency for self reflection in the group, which needed appropriate support. How creativity can be encouraged remains unclear. The value of multidisciplinary learning in this context was identified.The value of creative writing for medical education remains difficult to measure, but the participants agreed unanimously that the course would be an enjoyable way of encouraging medical students in its stated aims.

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What Does It Mean To Be A Doctor and a Writer?

Four physician-writers on their craft.

In this roundtable, four doctor-writers— Gavin Francis ( Shapeshifters: A Journey Through the Changing Human Body ), Sandeep Jauhar ( Heart: A History ), Paul Seward ( Patient Care: Death and Life in the Emergency Room ), and Jamie Weisman ( We Are Gathered )—discuss their craft, their practices, and what it means to be both.

__________________________________

In what ways does writing help you practice medicine and in what ways do you think it might hurt?

Jamie Weisman : William Faulkner said something to the effect that writing is a discovery process. When I start writing an essay or fiction I am never sure where the story or ideas will go, what will be the most important plot point or turn of phrase, and I think the same is often true for my patients. They have no way of knowing what detail is the key to understanding their disease. When I was a medical student, we were taught to ask open-ended questions. The first example was “What brought you to the clinic today?” (the joke was always that the patient would say, “the bus.”). Those open-ended questions are the same ones that start out an essay. For that matter, the questions posed to us in this Lit Hub piece are designed to be open-ended, and I am genuinely curious to hear my colleagues’ answers. So the short answer for me is that writing reminds me that I have to start somewhere with questioning but that the place I end up might be somewhere else entirely. I would also add that, literature shines a penetrating light on the lives of people I might not otherwise ever know, from Faulkner’s tortured Southerners to Nabokov’s repulsive Humbert Humbert and Toni Morrison’s brave and enduring descendents from slaves.

In terms of how writing might hurt medicine, there’s the obvious answer. Time spent writing or reading for pleasure is time not spent reading journals, seeing patients or volunteering indigent care. My skills as a doctor are in high demand, and if I wanted to participate in an activity that is demanding with little financial rewards, I could absolutely spend more time working for free, teaching or traveling to areas of underserved populations. One thing I love about medicine is that I am always learning. The pace of new discoveries in genetics and biochemistry is dizzying, and I could always read more.

Gavin Francis : Reading and writing helps us explore ways of being human, offers us a glimpse of the lives of others, broadens our circles of awareness. At its best you can say the same of medical practice—it offers privileged opportunities to see into and attempt to understand how other people see and experience the world. I love Osler’s old dictum that “it is much more important to know what sort of patient has a disease than what disease the patient has.” Medicine and literature share a kind of synergy in that way, and so it’s my impression that being a writer can only be beneficial to my work as a physician. It works to deepen engagement with the big questions of life—the ones that my patients are often struggling with themselves.

Paul Seward : Perhaps the greatest help was rest and solace. I find writing to be a solitary sport, a conversation with an invisible imaginary friend. And even when I am writing about medical practice, it is a practice that has been filtered through my thoughts, and my memories, and thereby reconstructed into something more coherent than it is in real life. I met an Episcopal priest once whose hobby was making clocks. He did all kinds, Desktop, Cuckoo clocks, wall clocks; you name it. If it could be encased in wood and ticked, he had probably made one. I asked him what I was about clocks that fascinated him. He said he really had no idea. All he knew was that, after a rough day in the pastor business, he could go upstairs to his workshop and lose all track of time. That’s writing for me.

Gavin Francis : I love the story of the clocks—thank you for that. It’s a seductive idea, that you can lose yourself, and lose track of time, in the construction of devices meant to track it. I don’t feel as if time disappears when I write, but certainly feel as if time writing is not away from medical practice—but reflecting on it, and deepening engagement with it. Refreshing and restoring and nourishing for another day in the clinic. A friend who works as a specialist academic commented: “It’s not such a bad model—to spend a day at the coalface of medicine, seeing patients, and then a day thinking about what you’ve done.” Sadly the time pressures of medicine mean that the division between writing and practising is rarely that balanced.

Sandeep Jauhar : Writing helps me reflect on and make sense of my experiences as a doctor. When I started writing, I usually wrote about things in the hospital that upset or confused me. Why are we putting a feeding tube into that elderly man when he says that eating—tasting food—is the greatest pleasure in his life? Would it not be better to let him eat, even if it meant he could aspirate the food and die of pneumonia? These are the sorts of conundrums that I wrestled with as a resident and propelled me to start writing. And the reflection encouraged me to practice more deliberately and humanely.

Of course, when you are in the midst of writing, there is a danger that you will view your participation in a patient’s care as part of a narrative that you have constructed. There is a danger that your actions will then become too deliberate, too self-conscious, that they will serve the demands of a story and not a patient. One must always guard against this possibility.

Jamie Weisman : I agree that when I write about medicine it helps me sort out my feelings and my conflicts, but writing fiction is my true literary calling. There’s a lot of medicine in my writing—my readers frequently have to tell me to tone down the doctor-ness or make it more accessible—but then again there’s a lot of illness and death in all writing, no? So I can clearly see how medicine helps me as a fiction writer—it opens a treasure trove of stories—but it is less clear how fiction helps me as a doctor. The trope is it makes me more empathic, but I know many empathic, generous souls who are doctors and read nothing but science.

Do your patients know you are a writer and do any of them read your work or bring it up with you? How do you think that might affect the doctor patient relationship?

Gavin Francis : Quite a substantial number of my patients know I write, and as regards how it affects the relationship, I think we’d need to ask them. I don’t let it affect the way I engage with my patients at all. It can be embarrassing to get to the end of a testing consultation and have a patient pull out a book and ask if you wouldn’t mind signing it.

Jamie Weisman : Most of my patients do not know I am a writer, and I try to keep those two parts of my life separate. My patients are there for my medical knowledge, not my thoughts on art (or politics), but since my first book was a memoir about my own struggles with illness, predating becoming a doctor, some patients read that book and seek me out as a doctor. Sometimes that process leads to a great doctor patient relationship—they understand how confusing illness is and how even for people in medical families diagnoses can be elusive. But it can certainly be awkward since there is a level of honest and self-revelation—in non-fiction and in fiction—that means patients know more about me than they need to. They know I’m not perfect. They know I have thoughts on sex and infidelity and pregnancy that are entirely human but not at all relevant to the doctor patient relationship.

Sandeep Jauhar: Many of my longstanding patients know I write. Some have even brought my books to the office to have them signed. I am happy to engage them, but I try to toggle quickly from a writer-reader relationship to a doctor-patient one.

Jamie Weisman : I’m with Sandeep on this one. I try to make a pretty clear divide, and frankly I don’t have time in my busy clinic to have literary discussions. Not sure what I’d do if one of my patients asked me to their book club.

Maimonides. Keats. Somerset Maugham. William Carlos Williams. Anton Chekhov. There is a long history of writer-doctors. Does any of their work resonate or inspire you and if so, whose work and how?

Gavin Francis : Of the list above the one I come back to again and again is William Carlos Williams: his The Practice is a compact masterclass in conveying the way that medicine offers us practitioners immense opportunities to engage with the wealth and diversity of humanity. Williams knew that being invited into people’s homes, at the extreme moments of their lives, is a privilege and a gift; he felt honored, even restored and liberated, by the clamour and turmoil of a busy clinic. I love Mikhail Bulgakov’s The Master & Margarita too, though there are only hints in it of his medical experience. One of the finest examinations of clinical practice I know was written in collaboration with a family physician, but the words were set down by John Berger—his A Fortunate Man captures the sense that there are many kinds of doctors, and one of the most fruitful ways to approach medicine is to see in it opportunities to witness the breadth of possibility inherent in human life.

Jamie Weisman : I love William Carlos Williams’ doctor stories for their brute honesty—his anxiety and anger and compassion when he has to wrestle with a child to treat her diphtheria is something I think many doctors can relate to. But of all of them Chekhov is my favorite and my inspiration. He rarely wrote directly about medicine, but medicine suffuses his wrting, from the many characters who are doctors or who are suffering from illness, to the inescapable fact that our lives are bracketed, and death comes for the rich and poor, the best and the worst of us. In his stories and plays, while his characters are so often bogged down in relatively minor concerns and gossip, it’s as if they are literally painted on a canvas with their date of death. Doctors are constantly reminded that we have limited time and that the body is fragile. We learn to compartmentalize this knowledge so that it doesn’t cripple us with fear and anxiety, and some of us feel it more acutely than others. When I read Chekhov I feel that the sense of time and frailty is so much a part of his existence and it leads to a depth of compassion I can only dream of and constantly reach for.

Paul Seward : Do not forget Rabelais—and above all, Conan Doyle. He, more than any of the others, used his practice of medicine very directly in his work, to the point of making the first-person narrator of his stories a practicing physician. On the other hand, the reason his stories are so good is not because they were medically informed—that was just window dressing and tricks—but because of his wonderful ear for character and personality. If he had been a sailor he still would have been a great writer, but then Watson would have wound up as Starbuck, Holmes would have been Ahab with Irene Adler as the White Whale.

Gavin Francis : It’s said Arthur Conan Doyle based Holmes on one of his clinical mentors, the Edinburgh surgeon Joseph Bell, who showed such extraordinary attentiveness to the minor details of each patient’s clothing, expression and bearing, that he could predict their occupation in a glance. That kind of curiosity about humanity—the awareness that details matter—is fundamental both to medicine and to the kind of writing I enjoy. One of my favourite passages in William Carlos Williams’s work is when he spells out how medical work nourished and sustained the passion for humanity that made him write: Was I not interested in man? There the thing was, right in front of me. I could touch it, smell it. It was myself, naked, just as it was, without a lie telling itself to me in its own terms… it was giving me terms, basic terms with which I could spell out matters as profound as I cared to think of.

Sandeep Jauhar : I am well aware of the grand tradition of writing in medicine and have enjoyed many of the doctor-writers mentioned, especially Chekhov. I also enjoy writing that is about doctors. One of my favorite pieces is also John Berger’s A Fortunate Man , about an English country doctor. It is still the best thing I’ve read about general medical practice.

Medicine is often described as an art not a science. In what ways do you find practicing medicine artful and is there a science to the art of writing? For that matter, what is the difference between art and science?

Gavin Francis : I’ve never found the distinction a useful one—for Hippocrates medicine was a techne, a word that meant something closer to what we describe as a craft, a knowhow, or even a technique. I like that medicine doesn’t need to be either—its work is the relief of human suffering, and that intention is carried in the meaning of words like “patient” (meaning “sufferer”) and “physician” (meaning someone who works with, or engages, with nature). To be a physician is to engage yourself with the nature of illness, and the nature of humanity, and that is neither fully an art nor a science. Much of diagnosis is about pattern recognition, and approaches the patient the way that an art critic would approach an artistic work, with highly attuned observation and looking for missteps, or a fray in the weave of a narrative. And the best doctors are those that can figure out how each patient will best receive a diagnosis, and how best to try to manage it—and that is a kind of art. But if you don’t have a grounding in the ways of science—of what’s dependable and verifiable—I don’t think you could work effectively or reliably as a physician.

Paul Seward: Medicine is not a science. Scientific studies can be done on medical patients, but that is not the practice of medicine. For me, medicine is a craft, a skilled trade, even if we do dress it up in a priestly suit. We take the facts and technology which science has discovered, and practice with them over and over again—not to create something new and artful—but rather something that has been perfected by many repetitions. In doing that, we are artisans, not artists. I see writing in much the same way. The artistic part is real, but the more important work is craftsmanship. I start out as an artist—Jackson Pollock specifically—grabbing bunches of words and throwing them at the screen, doing my best to judge nothing and withhold nothing. But then, when I have a big messy mass of inspiration piled on the screen in front of me, then I take out the sandpaper and begin the craft of hours and hours of putting words together smoothly.

Jamie Weisman : I think of science in terms of experiments. You set up the hypothesis, the framework for testing that hypothesis and you create an experiment the results of which should be replicable by any other person with the same ingredients and tools. I’m a dermatologist, though, so I know how far medicine is from that construct. We brag in dermatology that we have the most diseases of any speciality because we can see the disorder with our naked eyes, we can biopsy and describe pathology and we can give the disease a name, but that doesn’t mean we know why the patient has the disease or what it means beyond historical pattern. In most cases of medicine, objective or scientific findings like blood counts and biopsies are only a few pieces of the jigsaw puzzle. The art comes from asking the right questions—of the patient and ourselves—to figure out a few more puzzle pieces, but in the end there are always pieces missing, As far as science in writing, both science and writing require discipline, an open mind and a willingness to fail.

Sandeep Jauhar : Much of medical care is discretionary. Of course there are established protocols but it is not algorithmic. It’s a bit like chess: the openings have been worked out but you can still improvise. This is what I think of when I think about the “art” of medicine. How you talk with your patients, guide them, advocate for them, is up to you. Similarly, writing, unquestionably an art, benefits by obeying certain guidelines. You must make choices, but some choices are better than others. So, as for science, there are standards for good writing, too.

Jamie Weisman : We all seem in agreement about medicine as an art, but I know in the U.S. and the U.K. there’s a strong push towards standardization. The same protocol for stroke, heart attack, leukemia etc, and the zeitgeist in medicine now is that these protocols will lead to better outcomes. Obviously no one would ever want to standardize art, but seeing all of you agreeing that there is so much art to medicine, adaptation to each patient, different lines of questioning, I wonder if this push towards standardization will backfire and lead to worse results, or if we’re overstating how much art there is to our chosen profession.

Did you want to write before you became a physician or was it your experience as a physician that inspired you to start writing?

Paul Seward : I have always been writing, but nothing that anyone read. When I was in high school I wrote bad verse and little short stories. In college my writing was mostly focused on the fine art of writing papers, so that I could get good grades, so that I could get into medical school. Also, I wrote stacks of mediocre poetry, all dedicated to the general topic of not being in the dreams of the women of my dreams. That literary phase ceased when I met my wife. For the rest of the time, I have written unpublishable short stories here and there—all long gone; one unpublishable novel, more poetry, and volumes of philosophic speculation on the nature of consciousness and the Self. I even published a couple of those articles. I doubt that anyone actually read them. My reasons for wanting to be a physician were not so much literary as philosophical and practical: It seemed a good way to learn about what human beings were and then act on that information; and I couldn’t think of anything else I would rather do.

Gavin Francis : My first two books were travel books—the first was a narrative journey through the European Arctic ( True North ), and the second was an account of living in Antarctica for fourteen months, just a few hundred miles from the South Pole ( Empire Antarctica ). So writing for me came after writing about travel and exploration. There’s a lovely passage in Salinger’s Seymour: An Introduction where Seymour writes to his brother something along the lines of: you were a reader long before you were a writer—so write the book that you most want to read. That’s what I’ve always tried to do with my books—write them for my own enthusiasm and passion, each are books that, at the time I wrote them, are the ones I’d most want to pick up in a bookstore and read.

Jamie Weisman : Clearly all of us had a love of literature which translated to a desire to put pen to paper before we became doctors. And echoing Chekhov’s famous line that medicine is his wife and writing his mistress, the practicalities of medicine—as a defined career path with financial stability as well as intellectual and emotional rewards—called to all of us. I am not sure when Paul or Gavin decided to become doctors. I grew up in a family of doctors—father and grandfather—and we used to joke that for a certain generation of Jewish kids (boys really), the parents felt you could be anything you want when you grow up, and by that they meant any speciality within medicine. I went off to college to study literature and to write, and I do not think I would have become a doctor if I had not been felled by illness myself—the transition from patient to doctor is the subject of my first book. So my short answer to this is I wanted to be a writer long before I wanted to be a doctor, but I love being a doctor.

Gavin Francis : Thanks for those reflections—there had never been any doctors in my family before I qualified, but as a schoolboy it seemed to me a profession, or rather a trade, that offered so much: and understanding of the human body and its failings, an appreciation of the complexity of anatomy and physiology, a skill that would offer employment anywhere in the world, an opportunity to meet men, women and children from every kind of background and be able to do something very practical to help. And it’s natural for doctors to be storytellers I think—we have to appreciate the salient features of so many other stories every day, and we have to use stories to explain to each patient how we imagine them finding a way through their illness. In her book on Ovid’s Metamorphoses the writer and mythographer Marina Warner said of stories “they offer a way of imagining alternatives, mapping possibilities, exciting hope, warding off danger by forestalling it, casting spells of order on the unknown ahead.” And I’m convinced that at its best, the same can be said of medicine.

Sandeep Jauhar: Growing up, I was very interested in writing and journalism. But my father, a hard-nosed scientist, always viewed writing as an avocation. His favorite saying was “Nonscience is nonsense.” So I went to college and studied physics. It was my experience of a dear friend’s illness that turned me to medicine. By then I was well aware of the great tradition of writing in medicine and hoped to pursue it in some form. My brother jokes that I am the only doctor he knows who went to medical school to become a writer.

Gavin Francis is a physician and the award-winning author of four books, including Adventures in Human Being , Empire Antarctica ; and True North . A regular contributor to the London Review of Books , Guardian , and New York Review of Books , Francis lives in Edinburgh, Scotland.

Sandeep Jauhar , MD, PhD, is the director of the Heart Failure Program at Long Island Jewish Medical Center. He is the author of Doctored and Intern and writes regularly for The New York Times . His new book Heart: A History, will be published by FSG on September 18. He lives with his wife and their son and daughter on Long Island.

Paul Seward has been a physician for nearly fifty years, and has spent the majority of those years working in emergency rooms on both coasts. He is a graduate of Stanford University and Harvard Medical School, and did his internship and residency in Pediatrics at UC San Francisco. Seward is an Emeritus member of the American Academy of Pediatrics and the American College of Emergency Physicians. Now retired, he and his wife live in Vermont.

Jamie Weisman is the author of the memoir As I Live and Breathe: Notes of a Patient-Doctor . She runs her own private dermatology practice just outside of Atlanta, Georgia, where she lives with her husband, two daughters, and Great Pyrenees puppy. Her new novel, We Are Gathered , is published by Houghton Mifflin Harcourt.

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S E Gull 1 ,
R O’Flynn 2 ,
J Y L Hunter 3
1 School of Clinical Medicine, University of Cambridge; Cambridge, UK
2 Consultant Psychiatrist, Suffolk West Primary Care Trust, Bury St Edmunds, UK
3 Head of Learning Resources, West Suffolk Hospital, Bury St Edmunds, UK
Correspondence to:  Mrs S Gull, Consultant Obstetrician and Gynaecologist, Cambridge Graduate Course Supervisor, West Suffolk Hospital, Bury St Edmunds, Suffolk IP33 2QZ, UK;  segull{at}network.co.uk

Only six of the 12 participants produced a final piece of written work, with lack of self discipline being cited as the chief reason. There was a strong tendency for self reflection in the group, which needed appropriate support. How creativity can be encouraged remains unclear. The value of multidisciplinary learning in this context was identified.

The value of creative writing for medical education remains difficult to measure, but the participants agreed unanimously that the course would be an enjoyable way of encouraging medical students in its stated aims.

education, medical
multidisciplinary learning

https://doi.org/10.1136/mh.28.2.102

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Throughout the UK and abroad 1– 6 modules in humanities are being increasingly offered as part of undergraduate medical education. The graduate course in medicine at the University of Cambridge, which started in September 2001, provided the opportunity to consider how a strand in literature could be developed within the course. Creative writing workshops could be used to enable students to develop their creative and reflective thinking, whilst also developing their writing skills. A course was designed and piloted with a group of volunteer staff from a local district general hospital. This article will describe the development, delivery, and evaluation of the course, and will discuss the lessons learnt.

COURSE DESIGN

None of the authors involved in the project had any previous experience in delivering creative writing classes. The objectives of the pilot study were therefore primarily to gain experience of delivering this type of course prior to offering the course to medical students. The aim was also to assess the effectiveness of the course in meeting specified aims, and to identify any practical issues in its delivery.

PREPARATION: DEFINING AIMS

A literature search identified four specific interrelated aims for the course. These were to:

Get thoughts onto paper

Facilitate interpretation of narrative

Help express issues related to illness and death

Encourage creativity

Reflective writing has been described as a method of developing skills in interpretation of patient narrative. 7 This in turn may help doctors to acknowledge the plight of others and also to recognise their own personal journey in medicine. The importance of the patient’s narrative is central to the practice of medicine, 8, 9 with the exchange between the doctor and the patient taking narrative form.

Writing has been described as different from talking or thinking in having a deeper reflective and educative function. 10 It enables the writer to discover and clarify thoughts and ideas which remain unchanged on the page, and allows exploration of previously unacknowledged issues. Creative writing can also relieve stress and foster understanding. 10, 11 It was felt that this approach might be particularly refreshing for medical students, as it would give them the opportunity to be creative, rather than suffer the “scarcely tolerable burden of information that is imposed (which) taxes the memory but not the intellect” 12 by courses based on biomedical knowledge.

Whilst these published aims appealed to the authors, the decision to run a pilot study reflected a desire for practical experience as well as objective evidence of educational benefits. The pilot study consisted of seven 90 minute workshops (see box one), each with different objectives. It was agreed that by the end of the last workshop participants should have produced a piece of written work that was in some way related to their job in the hospital. This might test the fourth aim, that of encouraging creativity. The course was accompanied by a collection of resource material to act as stimuli: extracts from prose and poetry chosen for their relevance to the workshops.

A set of ground rules was included, which were agreed at the beginning of the course (see box two).

Recruitment

12 members of hospital staff were recruited, seven following personal invitation, and five as the result of an advertisement in the hospital library. Of these six were doctors and six non-medical, consisting of the librarian, a clinic receptionist, a medical records clerk, a personnel officer and two senior managers. There were nine women and three men. The objectives for the pilot study were explained during recruitment.

The workshops ran one evening a week for seven weeks within the hospital.

Questionnaires were given to participants at the beginning and the end of the course. The first questionnaire was designed as a “starting point” to get people to put pen to paper, but also to try to identify what participants hoped to gain from the course. The final questionnaire was focused on assessing whether the stated aims of the course had been met, and how the course could be improved. The authors were participants in the course and spent time after each workshop discussing and recording observations about the session. These were transcribed and later discussed again. Further informal discussion took place. Because of an agreement to maintain confidentiality about matters raised within the workshops, these discussions addressed process rather than content. RO facilitated the workshop “Leaving reality behind”, and SG facilitated the rest. JH was present as participant observer in five of the seven workshops.

Box one: the workshops

Motivations and blocks to writing: Within groups participants considered what motivated or blocked writing. They then carried out an exercise in retrieving memory onto paper. Writing a story: narrative and voice: Participants were asked to consider how character is defined. Based on a newspaper article, the group developed character profiles for two people, and redrafted them either more or less sympathetically. Participants then had to write a short story in their own time based on the characters. Forming words: anger and calm: Participants had to write down all the things that made them angry and then give vent to their anger on the page. Key words or phrases were then identified and shared. A similar exercise was then carried out using the word “calm”. Forming words: sorrow, pain, and joy: Participants were asked to bring their own examples of literature expressing these emotions. These were discussed in groups and then participants wrote about a painful experience, and shared their writing with a partner. A similar exercise was carried out with joy. Leaving reality behind: Participants were asked to record their dreams for a week. These were used as a basis for producing imaginative writing and a discussion on the nature of reality Plain English: Participants were asked to bring along examples of writing found within the hospital and to work on this to simplify it. Principles of post-structuralism were introduced On being a doctor: The final two weeks were given for participants to write a piece to do with their work in the hospital. These were presented and discussed. Participants were asked to reflect during this exercise on the original aims of the course.

Box two: ground rules

Bring writing paper, writing pen, and coloured pen for corrections

Observe silence when writing in a workshop—creative thought is impaired by superficial conversation

Try to write as much as possible in the given time—the movement of pen on paper sometimes produces material you had no idea about. You are not just working with the conscious mind

Don’t be too self conscious about the work produced—it’s raw, waiting to be worked on, you’re not trying to prove anything

Be supportive of each other and criticise constructively (Pendleton’s rules, www.trainer.org.uk/members/tools/pendleton_rules.htm )

Do not show off—it intimidates other people

Be prepared to share your work with others in the group, but maintain confidentiality outside the group.

Participants had the opportunity to see the final paper and to comment on and modify it.

Those who attended consistently maintained a high level of enthusiasm for the course, which was highly rated in the final questionnaire. The initial questionnaire showed that participants had different levels of experience of creative writing and a variety of expectations for the course. The latter were broadly in line with the stated aims of the course.

Some people were more vocal than others during the sessions, but this changed as the workshops proceeded. The quietest member became noticeably more confident and later made the comment that she had initially felt inhibited by “all those grand people”, but that this had changed as the course progressed. There were times when one member produced visible discomfort in another—for example, when discussing how to define someone’s character with reference to weight. There also appeared to be a competitive element between two of the men, which caused ongoing tension. Attendance was variable, the main reason given being conflicting commitments.

The delivery of the workshops went more or less according to the initial written plan. The main constraining factor was time. One and a half hours went by very quickly in all the workshops, and comments were made that this should be extended to two hours. There did not seem to be enough time to discuss, and to give feedback about, everyone’s work, although this could have been improved by breaking up into groups. Within smaller groups there was a tendency for freer discussion to take place.

The ground rules were stated at the first workshop, and again at the third as there were new participants. Some were easier to follow than others. The most difficult problem to deal with was a tendency amongst some members to show off their knowledge, which did have an inhibitory effect on others. Reminding the members of this rule helped and comments were made on several occasions about the high level of support the group developed for one another.

HOW WERE THE AIMS OF THE COURSE MET?

Getting thoughts onto paper.

The first workshop addressing blocks and motivations aimed at this, but it became a recurrent theme throughout the course. It was agreed that the only way to do this was just to do it and that this was “a good discipline to cultivate” (for doctors). Having the structure of the workshops helped, but there remained difficulties for some participants in developing the self discipline required to write outside this protected time. Problems identified included pressures from work and family, but also an admission of intellectual laziness. It was requested that a further ground rule be added, which was to do the homework promptly. This particularly applied to those who felt blocked about writing in the first place. A firm structure to the course seemed to be valued by participants in which to develop their own creativity, but self discipline seemed to be a crucial factor. Such a course must remain optional because of the level of motivation required to do it. Of the 12 people who began the course only six managed to produce a final piece. How the structure of such a course influences creativity invites further research. It was queried whether the word “creative” was superfluous, as all writing could be considered a creative act.

Facilitating interpretation of narrative

The second workshop describing characters from a newspaper article was aiming at this, but perhaps should be renamed “describing character”. Various issues were identified, including how much instant assessments of character are made based on stereotypes (of gender, age, appearance, etc), and how much this relates to the writer (or doctor/observer) rather than to the character as such.

Helping to express issues related to illness and death

The third and fourth workshops were primarily aimed at this, and were the most animated, with clear enjoyment from the participants, who became less inhibited about discussing their work. There appeared to be a therapeutic element to being given the opportunity to discuss emotional issues within a “safe haven”, and participants needed to be reminded that the aim was to develop creative writing skills rather than to express emotion. There was a tendency to self reflection, not just about medical practice but about other personal issues. Whilst this has been described as a possible benefit for doctors 13 there are dangers also in entering into areas of emotional pain. Tears were shed on several occasions (mainly from laughter rather than sorrow). If the workshops are to be offered to students then the consequences should be considered, with appropriate support if necessary.

Encouraging creativity

Workshops five and six were primarily designed for this, and these were the ones that received the most mixed response. “Leaving reality behind” required participants to change from writing about what they saw as rational to what they considered to be irrational, using their own dreams, with extracts from Sigmund Freud, James Joyce, and Vaslav Nijinsky as stimuli. Some participants found this difficult, perhaps unwilling to make the leap required from one fixed, “logical” view of how to write things to another, where there was no clear direction or ending. Others, however, found it exciting. One participant commented the “dreams are like life, with no clear beginning and no ending”. Workshop six similarly had a mixed reaction, and might have been improved if the objective had been more clearly stated, which was to consider the power of words, particularly in relation to medical practice. One participant commented that this was “ very difficult and over my head” (English was not her first language), although others were positive about the value of clear expression. SG, who facilitated the session, felt it was too prescriptive, and that the issues raised could be dealt with by incorporating them into the other workshops.

Whether true creativity can really be taught remains unclear, but it could be encouraged by giving permission to “give up” or challenge preconceived notions.

Only six participants were able to produce a final piece, which may suggest the course was only partly successful in this aim.

OTHER LESSONS LEARNT FROM THE COURSE

Reflections on medical education.

Of the six final pieces it was perhaps coincidental that four were to do with the participants’ own experience of medical education. Each one expressed the view that this had not prepared them for the realities of being a doctor, particularly the emotional or ethical aspects. This was something that will need to be considered in designing other aspects of the graduate course curriculum.

The value of a multidisciplinary group

The creative writing process provided a level playing field for doctors and non-medical staff, with no one individual being an authority. The presence of non-medical participants had definite advantages: barriers were broken down as the course proceeded, and participants seemed to see themselves and others less in the “official” role of doctor, manager, clerk, etc and more as individuals. This would seem to be desirable for good relations generally. The medical participants had much to learn about creative writing from their non-medical colleagues. In a module for students it would seem desirable to open the workshop to interested non-medical staff. Other initiatives have invited resident writers, which could be considered.

It was generally agreed that the course had been hugely enjoyable. Whether this should be an aim in itself is debatable, but in a medical course with a lot of prescriptive work this must be seen as a welcome relief. Enjoyment of writing could increase self confidence in the process of representing both themselves and others, which is part of being a doctor. It could also lead to reflection on the writing of others and enjoyment of reading.

Self reflection

The authors had not anticipated the amount of self reflection developed in the group beforehand. Whilst this was agreed to be a positive thing in terms of sorting out of values there were possible dangers in exploring emotional issues, which needs to be recognised. The focus must be on creative writing not the development of a psychotherapeutic group.

CONCLUSIONS

It was unanimously agreed that the course would be of value to medical students, yet it remains unclear how transferable the lessons learnt from this pilot study might be. The participants were self selected and therefore more motivated than others to gain from it. The final questionnaire gave little clue as to how useful the activity really was, both in the short and long term.

The course was enjoyable for all the participants, but also raised challenges, some of which had not been foreseen. The dynamic of the group was important, and ground rules appeared to play a key role. Raising emotional issues could lead to difficulties. The pilot study offered us valuable insight and experience, and challenges have been highlighted for those wishing to provide similar courses.

As a result of this experience we would wish to include multidisciplinary involvement for medical students, as this had an unexpectedly positive effect.

Acknowledgments

The authors would like to thank the following for their help and support in developing the creative writing workshops: Judith Eagle, Richard Horton, Joanne Lucas, Miranda Pearson, Tom Sherwood, Paul Siklos.

REFERENCES AND NOTES

↵ Charon R . Reading, writing and doctoring: literature and medicine. American Journal of the Medical Sciences 2000 ; 319 : 285 –91. OpenUrl CrossRef PubMed Web of Science
Clewlow C . Pass the scalpel and pencil. The Times Higher Education Supplement 2000 Nov 3: 21.
Clews G . A novel approach. BMA News Review 2000 Aug: 26–7.
Cohen PA , Fortin AH. Curriculum of literature and medicine for residents. Academic Medicine 1999 ; 74 : 578 –9. OpenUrl CrossRef PubMed
Gillis C . Med school writer in residence. National Post (Canada) 2000 Dec 7: A3.
↵ Hampshire AJ , Avery AJ. What can students learn from studying medicine in literature. Medical Education 2001 ; 35 : 687 –90. OpenUrl CrossRef PubMed Web of Science
↵ Charon R . The patient-physician relationship. Narrative medicine: a model for empathy, reflection, profession, and trust. Journal of the American Medical Association 2001 ; 286 : 1897 –902. OpenUrl CrossRef PubMed Web of Science
↵ Hurwitz B . Narrative and the practice of medicine. Lancet 2000 ; 356 : 2086 –9. OpenUrl CrossRef PubMed Web of Science
↵ Calman K . Stories at work: reflective writing for practitioners. Clinical Medicine 2001 ; 1 : 227 –9. OpenUrl Abstract / FREE Full Text
↵ Bolton G . Stories at work: reflective writing for practitioners. Lancet 1999 ; 354 : 241 –3. OpenUrl
↵ Singleton J , Luckhurst M. The creative writing handbook . Basingstoke: Macmillan Press Ltd, 1996.
↵ General Medical Council . Tomorrow’s doctors . London: Education Committee of the GMC, 1993.
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Why Premed Students Should Take Creative Writing

Word choice is just one element to explore in creative writing classes that can help you in medical school.

Premed Students: Take Creative Writing

Young bearded man sitting on sofa in living room and using laptop while his dog napping next to him

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While premed courses are typically solution-driven, creative writing classes allow students to explore questions without clear-cut answers.

In recent years, medical schools have embraced the humanities as essential to educating the next generation of doctors. This emphasis starts early, and most med schools now require prospective students to complete one or more humanities courses prior to matriculation.

Changing to a Premed Track: What to Know

Cassie Kosarek July 6, 2021

English courses are often a specific premedical requirement, and med schools may accept creative writing classes to fulfill this requirement if they are listed under English courses in an undergraduate course catalogue. If creative writing courses do count as English courses at your school, consider adding one to your premed coursework to develop skills you will need as a physician. Here are three major takeaways for such classes.

Consider How Word Choice Shapes How We View Stories

In an age when patients have access to their medical charts, being aware of how we relate their stories in their medical records has important implications for maintaining good doctor-patient rapport. For example, writing that a patient "reports drinking a glass of wine in the evenings" has a different tone than writing, "Patient admits to drinking a glass of wine in the evenings."

Creative writing classes can help you learn to choose your words carefully, knowing they will influence how others perceive a story. Use creative writing to explore the weight individual words carry and how they shape outside readers' attitudes toward the narrative. Being able to select diction that honestly relates a patient's story in a nonjudgmental way will prepare you for patient-centered medical documentation that supports the therapeutic alliance.

Empathize With Different Perspectives and Motivations

In an ideal world, patients would engage in preventative care, take their medications and always show up to visits with their doctors. Unfortunately, many of the choices patients make seem illogical in the context of the care doctors want to provide.

Being able to consider your patients' individual perspectives is useful in understanding behaviors that act as barriers to care and can help you identify ways to meet each patient's unique needs .

Creative writing encourages you to peer through the eyes of another. As you write from a perspective separate from your own, you consider vulnerabilities, motivations and experiences that shape a character's course, and you may find yourself better able to connect with the trials and mistakes of others – especially those of your future patients.

Explore Questions Without Clear-Cut Solutions

Traditional premed courses are solution-driven. There is a correct answer to physics problems, and the outcomes in an organic chemistry lab are predictable if procedures are followed correctly.

Creative writing classes expose you to a world in which there is no correct ending to a story or poem. Narratives may end with a tidy coming-together after a central conflict just as easily as they may end with loose ends and unresolved issues.

The solutions to patients' problems have a right answer less frequently than they are complicated by human and clinical factors that preclude a simple binary answer. Even something as simple as prescribing an antibiotic for strep throat can be fraught with issues like inability to afford the medicine, difficulty finding transportation to the clinic and an overbooked clinic schedule.

Creative writing classes can help you shed your expectations of simplicity within medical school and medicine, and encourage you to critically consider the nuances influencing clinical care.

10 Med Schools for Nonscience Majors

Group of students learn from doctors and nurses in medical school and do research and training together.

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Need a guide through the murky medical school admissions process? Medical School Admissions Doctor offers a roundup of expert and student voices in the field to guide prospective students in their pursuit of a medical education. The blog is currently authored by Dr. Ali Loftizadeh, Dr. Azadeh Salek and Zach Grimmett at Admissions Helpers , a provider of medical school application services; Dr. Renee Marinelli at MedSchoolCoach , a premed and med school admissions consultancy; Dr. Rachel Rizal, co-founder and CEO of the Cracking Med School Admissions consultancy; Dr. Cassie Kosarec at Varsity Tutors , an advertiser with U.S. News & World Report; Dr. Kathleen Franco, a med school emeritus professor and psychiatrist; and Liana Meffert, a fourth-year medical student at the University of Iowa's Carver College of Medicine and a writer for Admissions Helpers. Got a question? Email [email protected] .

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COMMENTS

Seven Doctors Project: Physicians Take on Creative Writing
A creative writing workshop rejuvenates healthcare workers and community members. ... In 2009, shortly after Kang joined the Seven Doctors Project and started writing novels, she also picked up ...
Creative Writing as a Medical Instrument
Listening and responding to patients' stories for over 20 years as an emergency physician has strengthened my appreciation for the many ways that the skills and principles drawn from writing fiction double as necessary clinical skills. The best medicine doesn't work on the wrong story, and the stories patients tell sometimes feel like first drafts—vital and fragile works-in-progress ...
Reclaiming Reflection: Creative Writing and the ...
Poetry and Reflection: a powerful tool for learning. This post is part of a series over the next three days on the theme of Creative Writing and Medical Humanities by Dr Eleanor Holmes (pen name Eliot North). As a GP Tutor I've delivered seminars on the patient centred medicine (PCM) component of Newcastle University's Medical Undergraduate (MBBS) course to 1 st and 2 nd year students, for ...
Could creative writing be a cure for overworked doctors?
Award-winning author and GP Melanie Cheng says creative writing helps her give better care. She's one of a growing number of medical professionals using one discipline to improve the other.
Why Health Care Professionals Should Write
The programs are interested in the benefits of the act of writing itself. The Yale Internal Medicine Residency Writers Workshop was created in 2003 to provide a creative outlet for residents in internal medicine. It offers doctors-in-training two full days out of their hectic schedules to just focus on writing.
First drafts: Why healthcare professionals should study creative writing
In my article, "Creative Writing as a Medical Instrument," I propose that for healthcare professionals to become story experts, they must think creatively, through the mind's eye of a writer. Studying the creative writing process by building stories from the ground up helps us become intimate and acutely sensitive to the elements of craft ...
Through the Kaleidoscope: Creative Writing in Healthcare Education
Creative writing as a discipline has its roots in other pedagogy including composition studies and literary studies. In my systematic review, participants in groups from these disciplines produced (as a percentage of the final 26 articles analysed): prose including novels and short stories (67%), poetry (48%) and playwriting (19%). ...
How Doctors Tell Stories: Writing Through the Practice of Medicine
Leslie Jamison is the New York Times bestselling author of The Recovering, The Empathy Exams, Make it Scream, Make it Burn, and a novel, The Gin Closet. She is a contributing writer at The New York Times Magazine, and her work has appeared in numerous other publications including The Atlantic, The Paris Review, and Harper's.
Medical Humanities & Creative Writing─────
SciArt in America Blog Post - "Creative Writing for the Physician". Psychology Today - "Doctors Writing Poetry". Stanford Medicine SCOPE Blog. For group of Stanford doctors, writing helps them "make sense" of experiences. Physician writers share a "global perspective on healing". Surgeon-author: "My intent is to let people know ...
In-verse reflection: structured creative writing exercises to promote
Reflective writing is increasingly seen as an important educational practice in medical and health professional education to help achieve desired learning outcomes such as communication, empathy, and professionalism (Moniz et al. 2015).Medical educators may use a variety of writing tasks and forms to engage students and foster reflection, including focused essays, journal entries, and creative ...
Narrative Medicine: Every Patient Has a Story
Reflective writing also provides a "safe space" for students to discuss the stresses of medical school and their professional fears, she added. Jake Measom, a fourth-year medical student at UNR, said that participating in the narrative medicine scholarly concentration has pushed him to be more creative in his approach to patient care.
Creative Writing in Medical School
Hillary Mullan is a third-year medical student at the University of Massachusetts. She is interested in the intersection of art and medicine. She believes that the creative process can be healing and has found that writing has helped her to process the complexities, challenges and joys of medical school. Currently, she is working on a project ...
Narrative Medicine
This class will guide all types of medical professionals (doctors, nurses, researchers, aides, social workers, etc.) through the various skills needed to write and publish narratives—personal stories of their experiences in health care (and those of others in the field). We will cover every step in the writing process, from brainstorming to ...
How writing helps medical students and doctors handle stress
More than 1,000 doctors, trauma nurses, respiratory therapists and other health care workers and their loved ones have participated in the Writing Medicine course. On Saturday mornings, they come together online to "pause, reflect, be creative and share," Braitman said.
Write it off: Physician Writers Group helps doctors process stress, get
"Doing patient care 100% of the time can make you feel drained. Writing absolutely revitalizes me." Before medical school, Ross's hobbies included music, sketching and acting - outlets for his creative energy that he really misses as a doctor.
Creative writing workshops for medical education: learning from a pilot
Abstract. A course in creative writing was designed as a possible tool in medical education. Twelve volunteers (six doctors and six non-medical staff) participated in seven workshops held weekly. Four aims were identified: to help put thoughts onto paper; to facilitate interpretation of narrative; to encourage expression of emotions related to ...
What Does It Mean To Be A Doctor and a Writer? ‹ Literary Hub
July 23, 2018. In this roundtable, four doctor-writers— Gavin Francis (Shapeshifters: A Journey Through the Changing Human Body), Sandeep Jauhar (Heart: A History), Paul Seward (Patient Care: Death and Life in the Emergency Room), and Jamie Weisman (We Are Gathered)—discuss their craft, their practices, and what it means to be both.
Creative writing workshops for medical education: learning from a pilot
A course in creative writing was designed as a possible tool in medical education. Twelve volunteers (six doctors and six non-medical staff) participated in seven workshops held weekly. Four aims were identified: to help put thoughts onto paper; to facilitate interpretation of narrative; to encourage expression of emotions related to illness and death, and to encourage creativity.
3 Reasons Premed Students Should Take a Creative Writing Class
How a Literature Course Can Benefit Premed Students. Creative writing classes can help you learn to choose your words carefully, knowing they will influence how others perceive a story. Use ...

Reclaiming Reflection: Creative Writing and the Medical Humanities (1)

Australian author and doctor Melanie Cheng reflects on the benefits of creative writing for healthcare professionals

Happier doctors

Healthier patients

A clearer perspective

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Why Health Care Professionals Should Write

First drafts: Why healthcare professionals should study creative writing

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COURSE DESIGN

PREPARATION: DEFINING AIMS

Recruitment

Box one: the workshops

Box two: ground rules

HOW WERE THE AIMS OF THE COURSE MET?

Facilitating interpretation of narrative

Helping to express issues related to illness and death

Encouraging creativity

OTHER LESSONS LEARNT FROM THE COURSE

The value of a multidisciplinary group

Self reflection