Introduction: Facilitating growth of interpersonal communication skills and emotional empathy has received significant attention in a time when technology creates an additional barrier. In an attempt to facilitate understanding of the various perspectives involved with difficult communication events and foster emotional empathy, our program incorporates the use of a reflective narrative focused on past frustrating or overwhelming interpersonal interactions in the learners’ professional experiences during the University of Louisville’s Primary Care Education Program ambulatory rotation at the Veterans Affairs affiliate. During this rotation, residents work with behaviorally flagged veterans (as labeled by the Behavioral Risk Committee) who have a high prevalence of psychiatric disorders (e.g., depression, anxiety, post-traumatic stress disorder, anger management issues, and schizoaffective disorder). Methods: After reviewing the exercise’s instructions as a group, residents are given approximately 15 minutes to write their response to a prompt asking them to describe a difficult or uncomfortable patient interaction they have either experienced or witnessed. They are then asked to read their responses out loud to each other in groups of two or three (preferably two) and respond to each other’s stories. A short debriefing session concludes the exercise. Results: This exercise has been generally well received by learners. One participant reported having gone on to explore journaling as a means of addressing emotions throughout training; another revisited a previous love of writing poetry; still another expanded the reflective narrative and submitted it to a medical literary journal. Furthermore, learners have continued to discuss the specifics of their work with colleagues and instructors after the exercise. Discussion: This activity adds to the literature already present on reflection through (1) its primary utilization with postgraduate medical trainees; (2) its brevity and simplicity, which allow utilization by these extremely busy learners; and (3) its incorporation of reading another’s work, bringing some of the aspects of narrative medicine into the realm of reflective writing. Since this activity is a single event, it can be modified to fit into many situations. It can also be used with different levels and types of learners in health care education. Results of such an implementation outside the original context would be quite valuable. Potential collaboration with another educator at another institution is being explored, including development of a formal educational assessment.
- Implement reflective learning through the reconsideration of events and perspectives.
- Provide examples of the importance of interpersonal interactions in successful patient care.
- Share stories of self-expression and self-examination with colleagues.
- Describe the role of imagination and storytelling in patient care.
- Contrast differences in perspectives in the discussion of specific interactions.
- Arboles E. Driving accountability to maximize results using the plus-delta tool. GoLeanSixSigma.com Web site. https://goleansixsigma.com/driving-accountability-to-maximize-results-using-the-plus-delta-tool/. Published May 1, 2012. Accessed July 25, 2015.
- Arroliga AC, Huber C, Myers JD, Dieckert JP, Wesson D. Leadership in health care for the 21st century: challenges and opportunities. Am J Med. 2014;127(3):246-249. http://dx.doi.org/10.1016/j.amjmed.2013.11.004
- Ash SL, Clayton PH, Atkinson MP. Integrating reflection and assessment to capture and improve student learning. Mich J Community Serv Learning. 2005;11(2);49-60.
- Branch WT Jr. The road to professionalism: reflective practice and reflective learning. Patient Educ Couns. 2010;80(3):327-332. http://dx.doi.org/10.1016/j.pec.2010.04.022
- Bronson P, Merryman A. Top Dog: The Science of Winning and Losing. New York, NY: Twelve; 2013.
- Charon R, Hermann N. Commentary: a sense of story, or why teach reflective writing? Acad Med. 2012;87(1):5-7. http://dx.doi.org/10.1097/ACM.0b013e31823a59c7
- Chen D, Lew R, Hershman W, Orlander J. A cross-sectional measurement of medical student empathy. J Gen Intern Med. 2007;22(10):1434-1438. 3. http://dx.doi.org/10.1007/s11606-007-0298-x
- Chou CL, Hirschmann K, Fortin AV, Lichstein P. The impact of a faculty learning community on professional and personal development: the Facilitator Training Program of the American Academy on Communication in Healthcare. Acad Med. 2014;89(7):1051-1056. http://dx.doi.org/10.1097/ACM.0000000000000268
- Crouch CH, Mazur E. Peer instruction: ten years of experience and results. Amer J Phys. 2001;69(9):970-977. http://dx.doi.org/10.1119/1.1374249
- Edgoose JYC, Regner CJ, Zakletskaia LI. BREATHE OUT: a randomized controlled trial of a structured intervention to improve clinician satisfaction with “difficult” visits. J Am Board Fam Med. 2015;28(1):13-20. http://dx.doi.org/10.3122/jabfm.2015.01.130323
- Nilson LB. Creating Self-Regulated Learners: Strategies to Strengthen Students’ Self-awareness and Learning Skills. Sterling, VA: Stylus Publishing; 2013.
- Tomasek T. Critical reading: using reading prompts to promote active engagement with text. Int J Teaching Learning Higher Educ. 2009;21(1):127-132.
- Westberg J, Jason H. Fostering learners’ reflection and self-assessment. Fam Med. 1994;26:278-282.
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