A Reflection on Reflecting

Letter jumble and pencil

By: Timothy Smile, MM, fourth-year medical student, Northeast Ohio Medical University

Medical school taught me to enjoy writing. It’s a funny thing to say, especially considering the perpetual deluge of scientific and clinical content presented throughout the curriculum. Nevertheless, through my university’s Human Values in Medicine (HVM) course, described in a recent Academic Medicine article, I learned to appreciate—and eventually rely upon—the tradition of reflective practice.

Through clinical faculty-led small group sessions with my peers, HVM quickly created a culture of trust and openness that initially seemed incongruent with my stereotype of medical school. I believe part of that success can be attributed to the timing of the course. Before meeting as a group, students were assigned articles, poems, short stories, and/or other materials that examined sensitive—and often uncomfortable—topics applicable to concurrent basic science modules. These topics included race, obesity, organ donation, burnout, snap judgments, and many others. Students were instructed to read the assignments and write a reflective essay about any reactions the readings evoked, submitting it to the faculty leaders prior to the in-person group meeting. Composing reflective practice essays provided an avenue for processing confusing or embarrassing thoughts/beliefs, venting frustrations, recounting an important anecdote, or exploring potentially profound thoughts related to the readings. Expressing ourselves through these essays also primed our groups for enlivened but respectful discussions, which included incredibly candid comments from the students as well as the faculty leaders.

What I didn’t realize until starting my clinical rotations was the way reflective practice equipped me to process challenging patient encounters and provided prophylaxis against bitterness. Lois was one of my first—and most challenging—patients of clinical rotations. Lois was a middle-aged lady to be admitted from the ED to my inpatient service for syncope. While I performed a full history, she revealed to me that her ex-husband had returned to town, that he had sexually assaulted her in the past, and that her ED visit was actually because she was afraid to be home alone. I was deeply moved by her tearful story, immediately collaborating with the social worker to help Lois. I spent the next two hours on the phone with every battered women’s shelter within a 40-mile radius of the hospital seeking respite for Lois, none of which had room for her. Eventually, I wearily walked back into the room to discuss any other potential options. When I arrived, Lois was cheerfully finishing her hospital meal and eventually explained to us that she fabricated everything because she was hungry and had no money for food. My feeling immediately after leaving her room was an amalgamation of frustration, embarrassment, betrayal, and fatigue. This inundation of confusing feelings later found voice through a reflective practice journaling session that proved to be a cathartic and healing experience for me. The essay that unfolded helped me to imagine the life experiences that brought Lois to the hospital that night, desperate, hungry, and alone. Thanks in part to this emotional equipment cultivated by the HVM curriculum, I now recognize that the care, comfort, and warmth Lois felt during her stay were real, and I’m thankful to have been a part of that.

I am fortunate to have studied at an institution that values humanism in medicine, and I anticipate relying upon reflective practice to help me grow as a caretaker throughout residency and beyond.

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