Original Publication
Open Access

Reflective Narrative Exercise

Published: October 7, 2015 | 10.15766/mep_2374-8265.10238

Included in this publication:

  • Reflective Narrative Exercise.pdf
  • Reflective Narrative Instructor's Guide.pdf

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Editor's Note: This publication predates our implementation of the Educational Summary Report in 2016 and thus displays a different format than newer publications.


Facilitating growth of interpersonal communication skills and emotional empathy has received significant attention in medical education. The need for targeted interventions has been highlighted through identification of detrimental behavior and through positive clinical outcomes correlated with providers with these specific skills. Simulations, role modeling, and lectures are somewhat removed from the learners’ personal experiences, however. In an attempt to facilitate understanding of the various perspectives involved with difficult communication events and foster emotional empathy, our program incorporated use of a reflective narrative, focused on past frustrating or overwhelming interpersonal interactions in the learners’ professional roles. This exercise was folded into the University of Louisville’s PRIME (Primary Care Education Program) ambulatory rotation at the Veterans Affairs affiliate; in this context, the residents work with behaviorally flagged veterans (as labeled by the Behavioral Risk Committee) who have a high prevalence of abnormal psychology.

This exercise has been generally well received by learners. In addition to a general positive review, one learner has reported going on to explore journaling as a means of addressing emotions throughout training, another has revisited a previous love of writing poetry, still another learner has expanded and submitted the reflective narrative to a medical literary journal, and many learners have continued to discuss the specifics of their work with colleagues and instructors after the exercise.

To promote self-directed learning through reflection and reconsideration of events and perspectives: The residents are given the prompt/instructions at the beginning of the month-long rotation to allow time for contemplation and exploration of previous events in their past. Additionally, as they read their stories to each other, previously unrecognized meanings and understandings are often revealed.
To highlight the importance of interpersonal interactions in successful patient care: The topic of the prompt focuses on difficult situations. Through this focus, negative outcomes (or a lack of preferred outcomes) associated with these uncomfortable conversations are revealed.
To provide a safe environment for self-expression and examination: This activity is completed approximately mid-month, allowing time for the creation of a positive learning environment and trust among the group members. The learners are also reminded of the need to provide a confidential and safe environment for each other at the beginning of the writing session.
To promote positive interaction among colleagues through personal storytelling: Since the learners read their stories to each other, they are sharing a part of their past . . . a sensitive part of their past. This sharing has resulted in bonding conversations among participants, as noted by faculty overseeing the activity.
To facilitate imagination as it relates to history (story) interpretation in patient care: The learner is advised that “although this is intended to be an exercise based upon a factual interaction, artistry and use of imagination are encouraged.” This instruction gives the learner permission to imagine how others involved in the chosen event might feel. The learner is reminded of this goal at the start of the writing session so as to avoid an “incident report” product.
To encourage appreciation of the variety of perspectives: The learner is asked to consider the perspective of others involved in the situation described and receives input from peers during the activity session.

Educational Objectives

At the end of this exercise, the learner will be able to:

  1. Implement reflective learning through the reconsideration of events and perspectives.
  2. Provide examples of the importance of interpersonal interactions in successful patient care.
  3. Share stories of self-expression and examination with colleagues.
  4. Describe the role of imagination and storytelling in patient care.
  5. Contrast differences in perspectives in the discussion of specific interaction(s).

Author Information

  • Lori Wagner, MD: University of Louisville School of Medicine
  • Linda Roth, PhD, MEd: Wayne State University School of Medicine

None to report.

None to report.


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Wagner L, Roth L. Reflective narrative exercise. MedEdPORTAL. 2015;11:10238. https://doi.org/10.15766/mep_2374-8265.10238