Starting with orientation, medical students do reflective writing throughout their Einstein careers. It’s part of the first- and second-year Introduction to Clinical Medicine course and the third-year Patients, Doctors and Communities (PDC) course, and is offered as an elective to fourth-year students.
In addition to leading an orientation workshop in reflective writing, Dr. Gross is a PDC small-group leader at Einstein and also the editor of Pulse: Voices from the Heart of Medicine
(pulsevoices.org), an online literary journal that publishes writing by healthcare professionals, students and patients. He also teaches reflective writing to family and social medicine residents at Montefiore. Depending upon the setting, writing topics may be suggested by a curriculum or by Dr. Gross, but students often choose to write about events that particularly moved them. Dr. Gross encourages them to read their stories aloud to one another; their responses are overwhelmingly supportive.
“Reflective writing is not about writing well or creating perfect sentences,” he says. “The aim is to get students in touch with their truest feelings and make sense of their experiences by putting them on paper.”
The third year may be the most crucial time for reflective writing. “Evidence indicates that as students go through medical school, they become more impatient and less empathetic, and have higher rates of depression,” notes Dr. Gross. “Those problems seem to peak during the third year, when students embark on their clerkships and are exposed to people who are sick and dying. Writing can serve to inoculate against burnout, cynicism, impatience and arrogance, and help students have compassion for their patients and themselves.”
Third-year student Paul Wojack was skeptical at first about the possible benefits. “My perspective changed when I began working with patients daily and often found myself in emotionally charged situations,” he says. “Writing about those experiences and sharing experiences is cathartic—I get to release emotions and realize I’m not alone, because I know from my classmates’ writing that we’re all having difficult patient encounters.”
Over the past decade, reflective writing has become increasingly common in medical education. Studies indicate that it’s more than just a warm and fuzzy addition. A systematic review of reflection as a learning tool published in the Journal of Graduate Medical Education found that reflective writing “has a positive impact on empathy, increases comfort with learning in complex situations and enhances engagement in the learning process.”
Sarah Stumbar, M.D., M.P.H., a family physician and 2015 graduate of Montefiore’s residency program in social medicine, studied reflective writing with Dr. Gross and continues to write. “Often, it will take me a few months during which I am thinking about a certain patient interaction,” says Dr. Stumbar, now an assistant professor of family medicine in the department of humanities, health and society at the Herbert Wertheim College of Medicine at Florida International University in Miami. “Writing helps me figure out how my patients’ stories are woven into my own story—of medicine, of humanity, of growing up.”
