1. Family Medicine and Community Health Write On! Crafting A Reflective Writer FMEC Nov 2, 2013 Hugh Silk, MD, MPH, FAAFP Clinical Associate Professor Sara Shields, MD Clinical Professor Tassy Hayden, MD, PGY 3 Noah Rosenberg, MD, PGY 2

2. Family Medicine and Community Health Objectives At the conclusion of this seminar participants will be able to: 1) Teach a reflective writing exercise 2) Share and list tools that are currently being used to encourage reflection with learners 3) Utilize practical teaching tips for reflection in real time while seeing patients with learners

3. Family Medicine and Community Health Reflection in Medicine: Why does it matter? better understand one’s strengths and weaknesses identify and question underlying values and beliefs acknowledge and challenge assumptions and bias acknowledge fears identify possible areas for improvement Reflection can lead to greater self-awareness, which in turn is a first step to positive change http://www.monash.edu.au/lls/llonline/writing/medicine/reflective/3.xml

4. Family Medicine and Community Health How does it matter? Noticing Making sense Making meaning Working with meaning Transformative learning (“metacognition”) Moon J. A handbook of reflective and experiential learning. Oxon, Engl: Routledge; 1999

5. Family Medicine and Community Health Goals for this kind of teaching Increased empathy for patients Greater cultural awareness Improved interpersonal relations Better communication More job satisfaction Encouraging next generation to consider family medicine

6. Family Medicine and Community Health What are you using to encourage reflection in your programs?

7. Family Medicine and Community Health A reflective writing exercise Reflective Writing Workshop – –Use examples to get learners going –a poem, photo, art work, short story –read/look then write with the learners; be an example and do the exercise too –then discuss

8. Family Medicine and Community Health Take 5 minutes to “free” write about one of the photos

9. Family Medicine and Community Health OTHER APPROACHES FOR REFLECTION

10. Family Medicine and Community Health Brief Encounters Have students and residents simply shadow you and then write about “what happened”; not the medicine, but the connection, the nuances – borrowed from Rita Charon End of patient encounter or end of day – use facilitative precepting – “how did that make you feel”; have learner write about it For advanced students – have them write about the patient experience rather than SOAP note

11. Family Medicine and Community Health Continuity Exercises Make reflection part of Orientation for learners to show how important it is Core teaching sessions each week – leave 10 minutes to write – use the topic of the day and think about a patent experience that is related; think about how this topic made you feel; write about a patient experience you have been thinking about but have not had time to write about

12. Family Medicine and Community Health Teach residents to stop and write in real time “continuous virtual journals” using Portfolio – give them a reason (requirement) and a goal (see listserve and contests below) Use writings for Primary Care Week – have a reading night or have excerpts on posters or on tables for students to read – encourages students to know “the rest of the story…”

13. Family Medicine and Community Health Contests – pick a faculty member who is reflective – make an award in their name – have people submit poems, essays, 55 word reflections, etc – chose 1st-3rd place and honourable mentions; publish on med school website, local/state journals; have winners read aloud Encourage writers to submit their work for publication

14. Family Medicine and Community Health Where to Read the Humanities or Publish Academic Medicine: “Medicine and the Arts” -- http://journals.lww.com/academicmedicine/pages/default.aspxhttp://journals.lww.com/academicmedicine/pages/default.aspx Academic Pediatrics “In the Moment – Personal Narratives” http://academicpedsjnl.nethttp://academicpedsjnl.net American Family Physician: “Close-ups”(patient narratives) -- www.aafp.org/online/en/home/publications/journals/afp.htmlwww.aafp.org/online/en/home/publications/journals/afp.html Annals of Family Medicine: “Reflections” - www.annfammed.orgwww.annfammed.org Annals of Internal Medicine: "On Being a Doctor/Patient” “Ad Libitum”(poems) “Ideas and Opinions” section -- www.annals.orgwww.annals.org Archives of Family Medicine -- http://archfami.ama-assn.org/http://archfami.ama-assn.org/ Ars Medica: A Journal of Medicine, the Arts, and Humanities -- www.ars-medica.ca/www.ars-medica.ca/ Bellevue Literary Review -- www.blreview.org/www.blreview.org/ Blood and Thunder, University of Oregon Health Sciences Center -- http://www.ouhsc.edu/bloodandthunder/http://www.ouhsc.edu/bloodandthunder/ British Medical Journal: “Personal Views” -- www.bmj.comwww.bmj.com Consultant: “Doctors" Stories: Tales from the Trenches” www.consultant360.comwww.consultant360.com Families, Systems and Health: “Poetry” “Photography” “55 Word essays” “Book Reviews”-- www.apa.org/pubs/journals/fsh/index.aspxwww.apa.org/pubs/journals/fsh/index.aspx Family Medicine: “Narrative Essays” and “Book and Media Reviews” section -- www.stfm.org/publications/familymedicine/index.cfmwww.stfm.org/publications/familymedicine/index.cfm Global Pulse: narratives, commentary, poetry, essays, fiction, and photography -- http://www.globalpulsejournal.comhttp://www.globalpulsejournal.com Health Affairs: “Narrative Matters” section -- www.healthaffairs.orgwww.healthaffairs.org Hektoen International -- http://www.hektoeninternational.orghttp://www.hektoeninternational.org Hospital Drive -- www.hospitaldrive.med.virginia.eduwww.hospitaldrive.med.virginia.edu The Intima: electronic journal to stimulate thought, reflection, and conversation about medicine, humanities and arts– www.theintima.orgwww.theintima.org In Training: the agora of the medical student community, http://in-training.org/http://in-training.org/ JAMA: “A Piece of My Mind” “Poetry and Medicine” “Commentary” -- www.jama.ama-assn.orgwww.jama.ama-assn.org Journal of the American Board of Family Practice: “Reflections on Family Medicine” essays, creative prose, or poetry- www.jabfm.orgwww.jabfm.org The American Academy of Hospice and Palliative Care Quarterly: http://www.aahpm.org/publications/default/index.htmlhttp://www.aahpm.org/publications/default/index.html Journal for Learning Through the Arts -- http://escholarship.org/uc/clta_ltahttp://escholarship.org/uc/clta_lta Journal of Medical Humanities -- www.springer.com/new+%26+forthcoming+titles+%28default%29/journal/10912www.springer.com/new+%26+forthcoming+titles+%28default%29/journal/10912 Lancet “Ethics” “Medicine and Art” “Literature and Medicine” -- www.thelancet.comwww.thelancet.com Literature and Medicine (Johns Hopkins) -- http://muse.jhu.edu/journals/literature_and_medicine/http://muse.jhu.edu/journals/literature_and_medicine/ Medical Humanities Online -- http://mh.bmj.com http://mh.bmj.com New England Journal of Medicine (NEJM): “Perspectives” “Photographs”-- http://content.nejm.org/ http://content.nejm.org/ Pulse--voices from the heart of medicine: stories, poems -- www.pulsemagazine.org www.pulsemagazine.org * List originated from Gross P, Reilly JM from the STFM Annual Conference in Vancouver April 2010 and the list borrowed from Jonathan Han

15. Family Medicine and Community Health Art museum exercises – connect with a local museum; have learners “round” with a docent and practice describing what they see; expand ways of seeing and describing

16. Family Medicine and Community Health Set up a department list serve for weekly or monthly reflective pieces – essays, poems, etc. Have a moderator. Include medical students on family medicine rotation, community docs, nurses, researchers, etc Aim for “success stories” of teaching, clinical accomplishments, “critical incidents”, etc

17. Family Medicine and Community Health Residents Writings Noah Tassy

18. Family Medicine and Community Health Other ideas Questions Comments