Pulse
Tales from the Clinic
Medical students use the written word to gain insight into their clinical experiences.
Three years ago, when family physician Therese Zink, M.D., M.P.H., began working with the University of Minnesota’s Rural Physician Associate Program (RPAP), her interest in teaching and writing unexpectedly converged. It happened as she was interacting online with the third-year medical students taking part in the program.
Training for nine months in far-flung rural clinics where they work closely with one preceptor or one group, the nearly 50 students keep in touch with the program by way of web-based assignments. In addition to taking tests and following required reading, they can post accounts of their day-to-day experiences, recounting what they saw in the clinic and how they felt about it. “These are often students’ first encounters with life events,” Zink says, “their first code, the first time they watch somebody die.”
Accounts of such events are an important part of training, says Kathleen Brooks, M.D., director of RPAP. Telling stories about their experiences helps students “practice self-reflection,” she explains. The ability to articulate their thoughts can help them better understand what they are feeling. In addition, the online bulletin board also prompts conversations between students about issues many of them are facing for the first time such as noncompliant patients or difficulties with managed care. But as Zink read the wide-ranging student posts, she found herself moved. “Some of the stories begged for a bigger audience,” she says.
From Experience to Essay
Zink, who has had her work published in the Journal of the American Medical Association (JAMA) among other publications and is the winner of Minnesota Medicine’s 2009 Medical Musings writing contest, saw a role for herself as both a physician preceptor and a writing mentor. “I emailed a few [students], asking if they’d be interested in expanding their stories,” she says. Some jumped at the opportunity to hone an account of a personal experience into a well-crafted essay. Zink began to work with a handful of students, making suggestions and guiding revisions by email.
What’s evolved since then resembles an informal, medically oriented master writing class. During the last three years, Zink has worked with three or four students a year, fine-tuning individual pieces of writing. “We track changes,” she explains of the computerized exchange. “I’ll say ‘What were you feeling here?’ and sometimes I ask them to go a little bit deeper.” She adds, “With some I do more reshaping.” When she feels an essay is ready, she’ll submit it to an appropriate journal: “I try to figure out the best venue for it.”
So far, the student essays have appeared in JAMA, Family Medicine, Minnesota Medicine, Academic Medicine, and the ejournal Pulse. Several of the pieces will appear in a book Zink has edited called The Country Doctor Revisited: A 21st Century Reader of Rural Health Care. The anthology of work from medical students and established physicians, nurses, and psychologists from across the United States is being published by Kent State University Press. It is due out in 2010.
The student essays span an array of topics, offering at once a glimpse of the medical world and the authors’ unique personal struggles as future physicians.
In one piece, Addie Licari, M.D., who as a medical student spent a night guarding a newborn in the nursery from potential abduction by an acquaintance of the biological mother who longed for a child, reflects on her decision with her husband to delay having a baby. “I thought about my choice to put having a family on hold,” she acknowledges in the essay published in Academic Medicine. Telling the story of that night, she owns up to her private conflict, wanting to have a baby but recognizing the need to give her career priority: “Trying to keep my damp eyes hidden, I helped the OB describe the birth [to the adoptive parents].”
In an essay that will make its first appearance in Zink’s anthology, Erik Brodt, M.D., describes a life-changing day in 2005 during his nine-month clerkship at North Country Regional Hospital in Bemidji. “I chose Bemidji to be close to my family and the three largest Minnesota Chippewa Reservations. I am Anishinaabe (Chippewa), and it was the perfect opportunity to invest in the Native community during medical school,” he writes. But nothing prepared him for the experience of being paged to the ER to attend to injured students after a young man went on a shooting rampage at Red Lake High School before committing suicide. The event shook him, as it shook the community. Describing his own healing process in the essay, he wonders about his future: “Medicine quickly teaches a young doctor there is plenty of joy and heartache. Will I be able to withstand repeated heartache striking so close to home?”
For Cesar Emilio Ercole, M.D., an experience with a patient who was an illegal immigrant explores the story of an individual who came to America to improve her life circumstances and the townspeople who held prejudices against newcomers. When the patient ended up causing a car accident that killed a passenger, the residents were unforgiving. Ercole was astounded not only by the response of the town but also by that of the patient, who seemed unable to comprehend the consequences of her actions. He crafted the essay, which appeared in Minnesota Medicine, to tell a story “that unfolded before my eyes,” he says. “Not everybody in the Cities would have gotten that experience… I was a small part of it, but it impacted the whole community.”
A Broader Mission
Even as the stories prompt the student authors to reflect, they also shed light on medicine. In some cases, their personal accounts have led to discussions about difficult topics. Raymond Christensen, M.D., associate director of RPAP, was surprised and dismayed to read an account from a female medical student about sexism in the workplace. He was able to use the student’s piece to facilitate conversations about professional conduct among physician leaders and even suggest changes in behavior at a clinic where students train. The articles “raise awareness,” he says, “and hopefully are read widely by students and faculty, and maybe even community physicians and others.”
For Zink, who’s put out a call to any RPAP student who may want to write about an experience, the task of editing and submitting student pieces will continue. She’s hoping a similar writing project may evolve sometime soon for other medical students at the University of Minnesota. Beyond gaining personal understanding, the experience of being published can be edifying for students, she says: “It’s fun for them to see their names in print.”—Kate Ledger