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Jo Marie Reilly, MD Johanna Shapiro, PhD
Channeling your Inner Yoda: Using reflective writing methodologies to promote wellness and insight in ourselves and our students Jo Marie Reilly, MD Johanna Shapiro, PhD
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Disclosures None
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Learning Objectives At the conclusion of this session, participants will: Describe reflective writing as a story-telling, story listening, creative, communal acts which promote healing in ourselves and others Describe the use of multiple short writing techniques as reflective exercises for increasing resilience, mindfulness and well-being and for developing new clinical insights and problem-solving difficult clinical encounters. Demonstrate and/or experience 8 short writing techniques to include poetry, Haiku, song, 55 word medical narrative, short prose, skits, or letter writing as brief, effective reflective exercises. Demonstrate and experience giving and receiving meaningful structured, constructive feedback on personal writing pieces to deepen awareness and reflection. Discuss how to integrate short writing narrative techniques into various clinical care and teaching settings.
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Session Breakdown Part 1: Brief description of reflective writing benefits Part 2: Review/description of 8 reflective writing tools and methodologies Part 3: Reflective writing Exercise #1 and #2 with structured debrief exercise Discussion of uses of reflective writing in clinical and and teaching settings
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Reflective Writing Medical humanities modality that allows for increased awareness, reflection, healing and resilience building through story telling
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Reflective Writing Acknowledges personal voice
Facilitates awareness of other points of view Explores emotion in self and others Focuses on the narrative structure of events Facilitates discovery of new meaning, insights
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Reflective Writing as Story-telling
Allows us to hear or tell the story of another without interruption or advice giving (fixing and problem-solving) Encourages generous listening, presence, witnessing, mindfulness and compassion (story-listening) Tells our stories to others- Let’s us find our voice Reveals the intersection between our stories and the patient’s story
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Reflective Writing as a Creative Act
Writing as an end in itself Pursues beauty & truth personal and local rather than universal and general Seeks to create order from chaos Through imagination, offers possibility of going beyond constraints of what is
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Reflective Writing as a Communal Act
Writing always has an audience Shared writing involves offering and receiving For writer, vulnerability and risk-taking For listener, presence and witnessing Shared writing requires A safe environment Willingness to not only hear but respect Shared writing can lead to Personal validation Reduced alienation Community building
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Reflective Writing Promotes Healing
Research suggests writing has beneficial psychological and even physical effects Reduced physical and psychological symptoms Improves immune function, Decreases physician visits, Improves wellbeing Increases sense of control, objectivity, and emotional resolution
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Reflective Writing: Noticing, Reflecting, Healing Ourselves & Others
Noticing: A clinician's heightened awareness and presence allows the hidden to become visible. Reflecting: Writing and sharing the story helps connect thinking with the heart and soul. Healing: Touching the vulnerable places in others, may help us heal the vulnerable places within ourselves.
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Potential Benefits of Writing for Health Professionals
Listen and respond to stories, as well as symptoms Incorporate imagination and creativity into patient interactions Cultivate mindfulness: intention, presence, awareness, curiosity Develop new insights and approaches based on appreciation of perspectives other than our own
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Potential Benefits of Writing for Health Professionals
Feel true empathy because of increased understanding of and familiarity with difficult emotions in self and others Counteract feelings of helplessness/frustration, promote active reflection Reduce isolation/restore sense of community with peers Encourage resiliency in teams and in self Experience resolution of difficult events or encounters
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PART TWO: REFLECTIVE WRITING TECHNIQUES
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8 Reflective Writing Techniques To Consider:
Reflective Essay Point of View Writing 55 Word Stories Letter Writing Poetry Haiku (5-7-5) Song Skits
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Reflective Essay Writing: Definition
Tell a reflective story of a memorable, inspiring, or troubling event How did you feel? How were you changed? What did you learn?
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Reflective Writing: Technique
Allows you to remember your initial understanding/interpretation of event Allows you to deepen Stand back Pause: What else might have been going on? Examine views and perspectives of others Consider previously unrecognized feelings of self and others Reflect on other meanings/interpretations of the event Interpret the relationship of event to past events and patterns Caution: Protect identity/confidentiality
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Point of View Writing: Definition
Adopts the patient’s (family member’s/supervisor’s/colleague’s) point of view Describes key events, interactions, and/or clinical encounters.
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Point of View Writing: Technique
Select a patient/family member/supervisor/colleague on basis of perceived difficulty or highly charged affect Write in the first person voice (“I”), relating that person’s perspective, thoughts, feelings about a recent encounter, or other event Use information actually known about the other from past encounters, but also imagine aspects of the person’s life/perspective that are unknown Caution: humility! Hold imaginings lightly, avoid attachment Protect identity
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55 Word Stories: Definition
Tell—in 55 words exactly—a story that helps us to understand, or to appreciate, something about a patient or about an experience of health care. Less intimidating for the “non-writer” More accessible for the “time-pressured” Immediacy to this form of self expression and reflection
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55 Word Stories: Technique
Select a patient, a health care experience which was surprising, challenging, uplifting, or troubling and in 55 words exactly, describe that experience. Write what immediately comes to mind, choosing action verbs and adjectives with deep impact and vivid imagery to convey a story briefly, succinctly and yet powerfully. Don’t hesitate if you are a few words over and under; You can go back and edit after your initial “story” is written
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Letter-Writing: Definition
Uses the format of a letter to address a patient or other with whom you have had a challenging/inspiring relationship or difficult/uplifting encounter Thank you Expressing feelings Asking forgiveness Saying goodbye
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Letter-Writing Technique
Select the individual with whom you are having difficulties, whom you want to thank, or with whom you wish to share Use standard letter format Express your feelings/ concerns honestly State what you hope will happen State how it might happen What you hope from the other What you hope from yourself
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Poetry: Definition Literary work in which special intensity is given to the expression of feelings and ideas by the use of distinctive style and rhythm Writing that formulates a concentrated imaginative awareness of experience in language chosen and arranged to create a specific emotional response through meaning, sound, and rhythm
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Poetry: Technique Many different forms of poetry
Ballad, elegy, limerick, pantoum, sonnet, sestina Focus today is on free verse Find a central image or scene Some aspect of your life NOW Memorable patient or family member encounter Something wise/shocking a colleague said to you Describe scene Pay attention to imagery, simile, metaphor, language Use concrete rather than abstract words Use rhyme scheme, meter, or free verse Avoid cliché, sentimentality
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Haiku: Definition Japanese form of poetry which uses a very specific format to convey an image and poetic expression: My hospital rounds I play guitar in one room Withdraw care in the next - Randy Robinson Torn tree limbs Cascading down a waterfall My patient seizing - Karen Richardson
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Haiku: Technique Choose a memorable setting, experience or scene
Write down images that convey this experience 3 lines 5-7-5 syllables Nature imagery Present tense Association between images
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Song: Definition Short poem or other set of words set to music and meant to be sung Consider a Rap, pop, folk, classical piece with a written prelude or musical score/composition with written lyrics
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Song: Technique Choose a significant uplifting or challenging patient or health event Write a short poem about it Compose lyrics/rap/musical score (or work with musically inclined partner) to reflect your musical interpretation of the event Steps 2 and 3 can be done simultaneously, sequentially, or in reverse order
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Skit: Definition A short, often satirical or humorous performance or work A short, serious dramatic piece A story in dialogue
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Skit: Technique Use a personal story or narrative
Write a dialogue that tells the story May take the form of a personal monologue, multiple persons or a video story, U Tube story Example: My Brain Tumor
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PART THREE: LET’S WRITE!
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Let’s Write #1 Choose one of the 8 modalities discussed
Write about a clinical situation that touched your emotions, a poignant moment personally or professionally, your musings on a topic, etc. Write for 15 minutes total: 10 minutes without editing; Then 5 minutes to review, make changes.
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Writings Forms Reflective essay writing Point of view writing
Letter writing 55 word story Poetry Haiku (5-7-5) Song Skit
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Small Group Discussion #1
Structured feedback
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REFLECTIVE WRITING STRUCTURED DERIEFING TOOL
Story listener’s reaction Story listener’s questions for writer Literary feedback for writer
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Large Group Discussion #1
What was it like to write? What was it like to give feedback? What was it like to receive feedback? What did you find most valuable/fun/meaningful? What aspect was most challenging?
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Let’s Write Again: #2! Writings forms Reflective essay writing
Point of view writing Letter writing 55 word story Poetry Haiku (5-7-5) Song Skit
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Small Group Feedback #2 Structured discussion
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REFLECTIVE WRITING STRUCTURED DERIEFING TOOL
Story listener’s reaction Story listener’s questions for writer Literary feedback for writer
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Final Large Group Discussion
How can you incorporate writing into your teaching and clinical work?
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Incorporating Writing into Teaching and Clinical Settings
Ground rounds/Morning rounds Morbidity and Mortality Reports Case presentations Balint Groups Teaching Settings: Lecture/discussions Post OSCA/OSCE Clerkship case/patient reflections Professionalism/Introduction to clinical medicine
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Final Questions/Comments/Contacts
Jo Marie Reilly, M.D., FAAFP Keck School of Medicine of USC Johanna Shapiro, PhD University of California, Irvine
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