January 2003 Reporter Home

Congressional Report: Congress Has Some Unfinished Business as New Term Begins

AAMC Efforts Help Roll Back CMS Paperwork Requirements

Innovations in Medical Education: Doctors-in-Training Learn How to Tell Stories

Healing Deep Wounds: Program at Bellevue / NYU Provides Care for Torture Survivors

Nursing Shortage Prompts Creative Solutions

Author Q&A: 'Sometimes Wrong, Never in Doubt'

'Flagging' Debate Continues; Data Show Score Fluctuations

A Word from the President

Viewpoint

"A Day in the Life of a Medical Student"

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Managing Editor Scott Harris sharris@aamc.org Staff Writer Elissa Fuchs efuchs@aamc.org

Innovations in Medical Education: Doctors-in-Training Learn How to Tell Stories

This is the first installment in a 2003 series of columns that will examine efforts to break new ground in medical education curricula.

The amount of information and the kinds of skills medical students are required to master are many and well known. Clearly, simply memorizing and regurgitating scientific jargon isn't enough. An increasing number of educators are coming to believe that narrative knowledge - the ability to listen to and tell stories - is a crucial skill that educators must try to instill in doctors-in-training. Recognizing this, many medical schools have incorporated literature electives in their curricula and have embarked on initiatives that promote writing and storytelling on the part of medical students. Examples of such initiatives are the two anthologies put together by faculty at Dartmouth Medical School and Columbia University College of Physicians and Surgeons.

'A Life in Medicine'

A Life in Medicine, a literary anthology edited by Robert Coles, M.D., and Dartmouth Medical School's Randy Testa, Ed.D., Joseph O'Donnell, M.D, Penny Armstrong, C.N.M., M.S.N., and M. Brownell Anderson, contains stories, essays, and poems used in literature and medicine electives. Some of the student writings from these classes are also included in the book.

The editors decided to organize the anthology around the four Medical School Objectives Project (MSOP) attributes: altruism, knowledge, skill, and duty. The MSOP is an AAMC initiative designed to create consensus within the academic medicine community on the skills, attitudes, and knowledge that graduating students should possess.

"There is not enough reflection on the attributes defined by MSOP in medical school or even in professional life nowadays," says Dr. O'Donnell, senior advising dean and a professor of medicine at Dartmouth.

"We hope our book works as a tool that leads to reflection and discussion by medical students on the things they are doing and learning. When we talk about concepts such as 'altruism' and 'duty' in medical circles, we can't always agree on their definitions, but the writings in this book allow us to at least get people thinking about the concepts they are trying to grasp," Dr. O'Donnell says.

During the literature classes taught to fourth-year Dartmouth students, they learned not only to become careful readers of stories, but also good storytellers. Ultimately, the goal was to produce doctors who are better communicators and who can carefully listen to and "read" their patients, explains Dr. O'Donnell.

Stories in the anthology also include pieces by greats such as Anton Chekhov, the 19th-century Russian playwright, short-story writer, and physician; and Walt Whitman, who served as a medic in the Civil War, among others.

Students' reflections: 'Let Me Listen To Your Heart'

Let Me Listen To Your Heart, a collection of 42 reflections by third-year medical students, was edited by Columbia University College of Physicians and Surgeons' David Svahn, M.D., and Alan Kozak, M.D. The students were required to write as part of their training in primary care medicine at Bassett Healthcare in Cooperstown, N.Y.

Much like Dr. O'Donnell, Dr. Svahn also thinks that by exposing medical students to literature and creative writing, educators pave the way for a generation of doctors who can better connect with their patients. "The essence of medicine is found in communication with patients, in learning how to identify what their concerns and complaints are when they visit their doctors," says Dr. Svahn.

"Despite our technology, the best diagnostic tool is not lab testing or imaging studies, it is what the patient tells us; his or her stories. Paying attention to literature will make us better interpreters of our patients' stories and better able to serve them and get to the heart of the problem," he says.

The idea to publish this book arose after the preceptors in charge of reviewing the student writings realized that the quality of their essays was too great for them not to be shared with the public. Essays in the book address a variety of topics, ranging from medical students' usual insecurity during their first trials at practicing clinical medicine to encounters with "difficult" patients.

One story titled "My Temple," starts with a description of what appears to be a medical student's typical clinical workday. The student concludes the story with an encouraging assessment on the meaning his future profession has come to hold in his life:

"I grin bitterly at how little I believe in the sorts of ideas for which people pray in churches and synagogues. In spite of this Godlessness, I do hear the voice of compassion. It asks me to touch patients gently, speak to them softly, and listen attentively. Perhaps I know how to pray after all. And perhaps I have also found my temple."

- Suria Santana, ssantana@aamc.org

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