Reflecting On Life In Medicine: A Curricular Innovation For Internal Medicine Residents

 

Introduction: There is growing evidence that integrating elements of humanities with clinical medicine is salutary for doctors and their patients. Incorporating humanities early in training may help junior physicians develop his/her skills in the “art” of medicine. We therefore developed a humanities curriculum for medical PGY1 residents, “Reflective Medicine,” and assessed its impact and value.

Methods: Reflective Medicine was delivered to groups of 2-6 PGY1s for 1 hour weekly during a four-week ambulatory block rotation. The sessions were led by the same 2 faculty with selected short readings and existential questions of medicine were explored: (i) “Who am I”? “Who are you to me”?1 and, “What is the meaning of life in medicine”?2; (ii) “How can we help our patients’ suffering”?3-5; (iii) “What sustains our passion”?6-8; and (iv) “How do we relate to diverse, multi-ethnic patients in a shrinking world”?9 and, “What is ultimately important in the practice of medicine”?10. Residents submitted anonymous quantitative and qualitative evaluations.

 

Results: 33 residents evaluated the experience for 2011-2012. The series was rated 8.4/10 overall, and the faculty 4.74/5.00 overall. The residents judged the sessions would affect their thinking (8.2) and their behavior (8.2) about doctoring. They found the sessions interesting (8.3), educational (8.1), recommended their continuation (100%), and considered them better than or equal to other departmental didactic activities (100%, p < 0.01). All provided neutral or favorable comments. Sixty-four percent characterized the series as “great”, “awesome”, “excellent”, “wonderful”, invaluable”, “refreshing” and/or “thought-provoking”. These data were comparable to those reported by one author regarding a “bedside humanities” curriculum at Saint Barnabas Medical Center (Livingston, NJ)11,12.

 

Discussion: We introduced faculty-facilitated guided reflective time in our residency curriculum. The sessions were framed by selected readings and covered fundamental issues in understanding oneself and one’s patients. The sessions were highly valued by residents and were judged as likely to affect their thinking about doctoring and future behavior as physicians. Our observations support that teaching residents to incorporate reflective time in their professional lives may lead to deeper appreciation of professional ideals and improved interpersonal and communication skills.

 

References. (1) LaCombe MA: Recent advances. Amer J Med 88:407-8, 1990. (2) Stead EA: Paid in full by the satisfactions of each day. Chapter 1. A Way of Thinking. A Primer on the Art of Being a Doctor. Carolina Acadmic Press, Durham, 1995, pp3-6. (3) Hall D: The ship pounding, and Kenyon J: The sick wife, in Ten Years of Medicine and the Arts, edited by LR Dittrich, AAMC, Washington DC, 2001, p 56. (4) It’s over Debbie, JAMA 259: 2143, 1988. (5) Pickrel K: Empty pockets. Ann Intern Med 139:525, 2003. (6) Sarosi GA: Attending rounds. Ann Intern Med 153:482, 2010. (7) Hellmann DB: Eurekapenia. The Pharos Spring 2003, pp 24-6. (8) Hines DW: Maestro Guillermo. Ann Intern Med 147:670, 2007. (9) Williams WC: A face of stone, in The Doctor Stories. New Directions, NY, 1984, pp78-87. (10) LaCombe MA: Last words, in Bedside. The Art of Medicine, University of Maine Press, Orono, 2010, pp 228-245. (11) Panush RS, Parikh A, Sapru S, Carlino A, Houng M, Wangenheim P, Yodice P, Rezai F, Gray E, Fless K, Patel, NJ, Eid MM, Levine D, Vyas D, McTigue M, Rosenberg H, Rokosz G, Bonamo J, Wilson D, Lacombe M: Rx: read two poems and call me in the morning. Bedside humanities improves resident performance and patient care. Association of Program Directors In Internal Medicine Spring Meeting, April 26-29, 2009; Panush RS, Parikh A, Sapru S, Carlino A, Houng M, Wangenheim P, Chauhan B, Eid MM: Rx: Read two poems and call me in the morning. A medical humanities curriculum improves resident performance and patient care. II. From the hospital to ambulatory care. Association of Program Directors In Internal Medicine Spring Meeting, Baltimore, MD, April 26-28, 2010. (12) Panush RS: Rheum With A View. Why I sometimes read poetry instead of medicine—and why you should too. The Rheumatologist, November 2011, pp 47-49.

Ben-Ari R, Hsieh E, Panush RS: Reflecting on life in medicine. A curricular innovation for residents. Association of Program Directors in Internal Medicine Fall Meeting, Alliance for Academic Internal Medicine, Phoenix, AZ, October 2012, reprinted with permission from the authors.

 

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