By: MK Czerwiec, RN, MA
MK Czerwiec, also known as Comic Nurse, is the artist-in-residence at Northwestern University The Feinberg School of Medicine. She is a guest cartoonist for the Mayo Clinic Center for Innovation Blog. More on her comics and teaching can be found at www.comicnurse.com.
When they come to the doctor, people want someone to listen to them. That was the heart of the clinical encounter. I wanted to get to that, I wanted to remember that. –Peter Kim, second-year medical student
The drawing above was created in response to an intentionally simple prompt: “Draw the clinical encounter.” This exercise is part of a five-week medical humanities seminar titled, “Drawing Medicine” at Northwestern University The Feinberg School of Medicine. When he created this drawing as a first-year medical student, Peter described it to the class, saying that he is the figure on the left, and his patient is on the right. A year after drawing the piece, Peter said, “It’s reassuring to look at now. I’m glad I did the drawing because I can see now how people change, going through this process. It’s such a rigorous training. There’s only so much head space and as we gain clinical competencies, and worry about how we’re being graded, sometimes thinking about the patient’s feelings can get pushed out.”
I thought of this image when I read Wear and colleague’s recent perspective, which calls for opportunities for medical students to “more fully comprehend their patients’ distress and bewilderment at being ill, their suffering, their moments of transcendence, their healing, or to more fully comprehend the impact of these experiences on students’ professional identity development.” In addition to the wonderful examples of “reflective exploration” activities the authors describe, I would like to suggest drawing. When students draw in my seminar, and discuss their work afterwards, we are engaged in exactly the kind of “quiet moments of thoughtful reflection and dialogue, of appreciation and understanding” the authors promote.
Drawing has deep roots in our brains and in our histories. Drawing connects disparate parts of each in new ways, often leading to insights that might not have been otherwise achieved.
My colleague Michael Green testifies to the power of drawing in his recent innovation report. He notes, “Overlooking graphical or visual methods of reflection is a missed opportunity because visual depictions can both describe and show how particular experiences contribute to students’ [professional identity formation].” He goes on to say, “having students create comics provides an opportunity for them to reflect on the varied experiences that have shaped their professional identities.”
My students also create comics in my seminar, and though I haven’t analyzed my students’ comics as Michael has, I’ve seen similar themes emerge, and agree that a great deal of contemplation about professional identity formation happens as students combine words and images. When we discuss their comics, their words reflect what Michael’s students experienced—that “creating a comic about a formative experience provides an opportunity for reflection that influences how they intend to relate to patients in the future.”
Kelsey Kaneshiro created the comic below as a first-year medical student. It shares her experience visiting her grandmother in the hospital prior to starting medical school.
Describing this comic to the class, Kelsey said, “My thoughts about the inpatient hospital environment were: The hospital is confusing. The hospital is intimidating. The hospital environment is not very accommodating to those who are not in the medical field, e.g., families. I saw it was scary for my family and I wanted, but failed, to be the bridge. [I was drawing] my struggle to try to interpret it all as I was making my own move towards being a ‘not in medicine person’ to an ‘in medicine person.’ Drawing this helped me realize that the hospital environment can be a trigger for family chaos, even if the patient is just in the bed, sitting there.”
Reflecting on her experience with drawing, Kelsey writes, “The process of deciding what to draw and how best to represent a concept to a viewer makes you pick apart thoughts. Drawing makes you really refine your thoughts and be reflective. It conveys your true feelings not only to your viewer but also to yourself.”
Now a third-year medical student, Kelsey contemplates her developing professional identity, “When I look at the comic now, I remember those feelings and compare it to where I am now. I am much, much more comfortable with the hospital, even though some of the things still elude me. I am, however, afraid of being the speech bubble, faceless doctor that is not in the comic. I immediately thought—man, I hope I don’t use too much jargon. I hope I do enough to reassure family members when I am on rounds, or in the room counseling. What can I do to make it better?”
Readers can find more on my “Drawing Medicine” seminar at Northwestern University and Michael Green’s work with comics at Penn State Hershey in the forthcoming Graphic Medicine Manifesto due from Penn State University Press in May 2015 (http://www.psupress.org/books/titles/978-0-271-06649-3.html).