Reading the Self: Medical Students' Experience of Reflecting on Their Writing Over Time

Hetty Cunningham; Delphine S Taylor; Urmi A Desai; Katherine L Ender; Julie Glickstein; Usha S Krishnan; Boyd F Richards; Rita Charon; Dorene F Balmer

doi:10.1097/ACM.0000000000003814

Reading the Self: Medical Students' Experience of Reflecting on Their Writing Over Time

Acad Med. 2021 Aug 1;96(8):1168-1174. doi: 10.1097/ACM.0000000000003814. Epub 2020 Nov 3.

Authors

Hetty Cunningham¹, Delphine S Taylor², Urmi A Desai³, Katherine L Ender⁴, Julie Glickstein⁵, Usha S Krishnan⁶, Boyd F Richards⁷, Rita Charon⁸, Dorene F Balmer⁹

Affiliations

¹ H. Cunningham is associate professor of pediatrics, Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, Columbia University, New York, New York; ORCID: https://orcid.org/0000-0003-1686-0497 .
² D.S. Taylor is associate professor of medicine, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York; ORCID: https://orcid.org/0000-0002-1999-0388 .
³ U.A. Desai is assistant professor of medicine, Center for Family and Community Medicine, Columbia University Irving Medical Center, Columbia University, New York, New York.
⁴ K.L. Ender is assistant professor of pediatrics, Department of Pediatrics, Columbia University Irving Medical Center, Columbia University, New York, New York.
⁵ J. Glickstein is professor of pediatrics, Department of Pediatrics, Columbia University Irving Medical Center, Columbia University, New York, New York.
⁶ U.S. Krishnan is professor of pediatrics, Department of Pediatrics, Columbia University Irving Medical Center, Columbia University, New York, New York; ORCID: https://orcid.org/0000-0002-5733-6096 .
⁷ B.F. Richards is professor of pediatrics, Department of Pediatrics, University of Utah, Salt Lake City, Utah; ORCID: https://orcid.org/0000-0002-1864-7238 .
⁸ R. Charon is professor of medicine, Department of Medicine, and professor of medical humanities & ethics, Department of Medical Humanities & Ethics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York; ORCID: https://orcid.org/0000-0002-6003-5219 .
⁹ D.F. Balmer is associate professor of pediatrics, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0001-6805-4062 .

PMID: 33149084
DOI: 10.1097/ACM.0000000000003814

Abstract

Purpose: To investigate students' experience (over time) with meta-reflection writing exercises, called Signature Reflections. These exercises were used to strengthen reflective capacity, as part of a 4-year reflective writing portfolio curriculum that builds on a recognized strategy for reflection (narrative medicine) and employs longitudinal faculty-mentors.

Method: In 2018, the authors conducted 5 focus groups with 18 third-year students from the Columbia University Vagelos College of Physicians and Surgeons class of 2019 to examine students' experience with Signature Reflections. Using an iterative, thematic approach, they developed codes to reflect common patterns in the transcripts, distilled conceptually similar codes, and assembled the code categories into themes.

Results: Three core themes (safe space, narrative experience, mirror of self) and 1 overarching theme (moving through time) were identified. Students frequently experienced relief at having a safe reflective space that promoted grappling with their fears or vulnerabilities and highlighted contextual factors (e.g., trusted faculty-mentors, protected time) that fostered a safe space for reflection and exploration. They often emphasized the value of tangible documentation of their medical school journey (narrative experience) and reported using Signature Reflections to examine their emerging identity (mirror of self). Overlapping with the core themes was a deep appreciation for the temporal perspective facilitated by the Signature Reflections (moving through time).

Conclusions: A longitudinal narrative medicine-based portfolio curriculum with pauses for meta-reflection allowed students, with faculty support, to observe their trajectory through medical school, explore fears and vulnerabilities, and narrate their own growth. Findings suggest that narrative medicine curricula should be required and sufficiently longitudinal to facilitate opportunities to practice the skill of writing for insight, foster relationships with faculty, and strengthen students' temporal perspectives of their development.

MeSH terms

Curriculum
Focus Groups
Humans
Narration
Students, Medical*
Writing