University of Iowa medical students find their creative voice

This fall, faculty at the University of Iowa Carver College of Medicine are planning to implement a curriculum redesign, which in part will place more opportunities for creative writing and reflection in front of all students.

College leaders are hopeful this heightened focus on the humanities will lead to graduating more well-rounded physicians.

On May 1, Mgbechi Erondu, a second-year medical student, performed a piece as a part of “Wounds” - a play comprised of writings from 11 medical students.

The students are enrolled in an elective writing course, offered to first- and second-year medical students, and were asked to reflect on wounds they experienced or witnessed. Erondu told the story of a mother and young daughter from Batswana fighting a losing battle with HIV.

“Writing gave me words for my feelings, allowed me to explore them,” Erondu said of her piece, which she developed from a 10-month fellowship to Batswana. “These were children who were born with HIV. I tried to wrap my mind around what it would be like growing up with that disease.”

Creative writing

The UI Carver College of Medicine has housed a writing and humanities program for the past decade.

And while it started as an auxiliary department aiding students with writing personal statements for residency applications, it has grown to offer elective writing courses for self-selecting students interested in receiving a humanities distinction.

However, that remains a small subsection of the medical school population, and school officials say they see the value in increasing the frequency of humanities-based assignments in general coursework.

“I think most people don't come into (medical school) identifying themselves as creative writers,” said Kristi Ferguson, a professor of general internal medicine and director of the Medicine and Society strand of the new curriculum. “And I am not sure that is something we can create, but I think we can create reflective practitioners and some of that will include creative writing.”

Reflection is something Jason Lewis, the director of the medical school's writing and humanities program and instructor of many of the elective courses currently offered, said is an important skill students need for maintaining lucidity through their years of practice.

“It seems to me that it is pretty universally accepted - in order to stave off burnout and be a more humanistic physician overall - that building these skills are beneficial,” Lewis said. “I think where the conversation really starts to get complex is how do you build that into a medical school curriculum where there is so much information that needs to be taken in.”

Lewis said he is in talks with Ferguson about including simple assignments, like a six-word short story, into the Medicine and Society strand's first-year courses, and as the students progress through their four years, having those assignments grow in complexity.

“(The students will have) a group of assignments they have done that relate to one another in such a way that when they have to write their personal statement going into fourth year, they might have not known it at the time, but they were thinking about who they are, what their story is, and why it matters to them to go to the next place,” Lewis said.

National appeal

The idea of molding young doctors into well-rounded physicians also is being embraced nationally.

The MCAT - the national exam taken by incoming medical students - will be redesigned by 2015 to include a new critical analysis and reasoning skills section.

“(The test will) have more ethics and writings, and going after a different type of student. It is going to be a whole-person focus,” said Debra Schwinn, dean of the UI's college of medicine. “I think it is recognizing the biomedical view of medicine is a good foundation, but you have to be a passionate, caring, and ethical person as well.”

However, fledgling medical students are not the only group in the medical world focused on how the humanities can intertwine with medicine.

“Probably the biggest coping mechanism people learned in the time I was trained was to build a wall between you and a patient so their emotional anguish does not spill over into your decision making process,” said Carol Scott-Conner, a professor of surgery at the medical school and published author. “But the reflective process associated with writing offers you another way to respond and access that anguish without having it effect your decision making.”

But not all doctor writers promote the reflective process as the most valuable portion of creative writing.

“Oddly enough, I think one of the ways it really helps is being trained in the workshop process, where you read and then others discuss your work,” said Hilary Mosher, a clinical assistant professor at the college of medicine who studied creative writing before attending medical school. “We don't get to have a voice in defending our writing in that initial discussion.”

Mosher said by removing the ability to defend your work at the outset, a writer learns not only to communicate more effectively, but also to accept and grow from criticism.

“I probably have miscommunicated (to patients),” Mosher said. “I have been able to, very quickly, in the space of that encounter, realize my miscommunication and sort of remedy it more effectively and with less of a sense of defensiveness or ego than I would have if I hadn't been in writing workshop.”