‘The Loss of My Elderly Patient:’ Interactive reflective writing to support medical students’ rites of passage

Abstract

Background: The fostering of reflective capacity within medical education helps develop critical thinking and clinical reasoning skills and enhances professionalism. Use of reflective narratives to augment reflective practice instruction is well documented.

Aim: At Warren Alpert Medical School of Brown University (Alpert Med), a narrative medicine curriculum innovation of students’ reflective writing (field notes) with individualized feedback from an interdisciplinary faculty team (in pre-clinical years) has been implemented in a Doctoring course to cultivate reflective capacity, empathy, and humanism. Interactive reflective writing (student writer/faculty feedback provider dyad), we propose, can additionally support students with rites of passage at critical educational junctures.

Method: At Alpert Med, we have devised a tool to guide faculty in crafting quality feedback, i.e. the Brown Educational Guide to Analysis of Narrative (BEGAN) which includes identifying students’ salient quotes, utilizing reflection-inviting questions and close reading, highlighting derived lessons/key concepts, extracting clinical patterns, and providing concrete recommendations as relevant.

Results: We provide an example of a student's narrative describing an emotionally powerful and meaningful event – the loss of his first patient – and faculty responses using BEGAN.

Conclusion: The provision of quality feedback to students’ reflective writing – supported by BEGAN – can facilitate the transformation of student to professional through reflection within medical education.

Additional information

Notes on contributors

Hedy S. Wald

HEDY S. WALD, PhD, is a clinical assistant professor of Family Medicine, Warren Alpert Medical School of Brown University, a psychologist with advanced training in Narrative Medicine and Neuropsychological Assessment, and a reflective writing consultant to the Doctoring course and Family Medicine clerkship. She conducts research on use of reflective writing and faculty feedback in medical education.

Shmuel P. Reis

SHMUEL P. REIS, MD, MHPE, is a professor and chair, Division of Family Medicine, Technion-Israel Institute of Technology, Haifa, Israel, and an adjunct associate professor, Alpert Medical School. He is a medical educator with expertise in Medical Education and Narrative Medicine and conducts research on use of reflective writing and faculty feedback in medical education.

Alicia D. Monroe

ALICIA D. MONROE, MD, is the vice dean for Educational Affairs, professor of Family Medicine, University of South Florida College of Medicine. She was previously an associate dean for Diversity and the course director and curriculum developer for the Alpert Medical School Doctoring course. She has extensive experience in leading workshops for clinicians and students.

Jeffrey M. Borkan

JEFFREY M. BORKAN, MD, PhD, is professor and chair, Department of Family Medicine, Warren Alpert Medical School of Brown University and a key contributor to the Doctoring course. His training and expertise in medicine, anthropology, mixed methods research, and Narrative Medicine has helped to guide the use of reflection in the Doctoring course.