Reflection by Lucas Axiotakis M.D., Kensington Cochran, Jude Okonkwo, W. Conor Rork and Owen Lewis, M.D.
Within the medical curriculum at the Columbia Vagelos College of Physicians and Surgeons, there is a well-articulated program of Narrative Medicine Training from the first through final semesters (Charon et al, 1995, 2016; Devlin et al, 2015; Cunningham et al, 2018). Over the first three pre-clinical semesters, Fundamentals of Clinical Medicine (FCM) incorporates weekly small group interactive discussion, often including group reading and reflection on short selections of poetry and literature. The overall aim is to model and teach reflection as a core skill in medicine.
Within the second semester of the FCM course, there is a required six week intensive elective in one of twelve art focused seminars. The Poetry Reading and Craft Seminar is one such elective. Others include playwriting, fiction writing, photography, art, and dance. to name a few.
The structure of the Poetry Reading and Craft Seminar has been reported in this and other journals (Lewis, Schillace, 2019; Lewis, Jetté, 2023) as has been the instructor’s observations of impact (Lewis, 2023). This report highlights several student observations and reflections. The first author (L.A.) is in an ENT residency, the next three (K.C., J.O., and C.R.) are in various years of medical school
Frequently throughout FCM, students are asked to write reflections on teaching activities, and the two questions reported below were part of these reflections.
What stands out about what you learned about poetry?
(K.C.) In our first poetry class, we talked about whitespace. Not empty space or stressed space, needing to be filled; but, instead, intentional space, quite space, space for words to sit and thoughts to breathe.
(W.C.) The experience gave me a great foundation in thinking about rhythm, rhyme, and diction, I had previously never fully considered how form doesn’t merely convey but shapes the ideas and themes of the poem itself.
(J.O) Sharing poetry requires courage and willingness to share your approach with the world, to allow yourself to be in conversation with both colleagues and lay people alike and to see the dose-response of your work.
(L.A.) The two most notable strengths of the course were the development a deeper understanding of the role of voice in poetry, and the ability to workshop with a host of fellow medical student writers, which opened my eyes to the natural writing proclivities so many student doctors have.
What have you learned that makes you a better physician?
(K.C.) As medical students, our days are full of firsts: the first time we witness a birth, the first time we cut into a human body, the first time we make a mistake that causes a patient harm, the first time a family thanks us for our care, the first time we witness a patient death. In the breakneck pace of medical school, these firsts blend into the exhaustion of the daily routine – until the world slows down for a moment. On the train, in the shower, in the moments before sleep, these firsts come slamming back, with all their joy and despair. Poetry’s short form lends to these cramped moments for reflection, and its endlessly revisable property allows my written reflections to iterate and evolve with my own complex perspectives.
(W.R.) In a philosophy of medicine group I’m involved in, we recently discussed the power of ‘transfiguring attention’ in the medical encounter. By attending to the ‘Other’ (e.g. a patient) in all of her complexity we can practice better medicine. The idea of cultivating a ‘transfiguring attention’ is that it serves as a sort of antidote to the complacency bred by familiarity and repetition, allowing us to remain open to the imaginative possibility of wonder. I didn’t have this language while I was in our poetry class last spring, but I think that it captures how my own poetry practice may bleed into the other practices of my life as a future physician.
(J.O.) The course helped me in the continued development of my creativity, empathy and self-criticism. One could argue that the process of writing poetry and that poetry itself is a kind of medicine. I have learned in writing poetry how to diagnose and synthesise my experiences, formulate and conceptualize methods of expressing language that reflects them properly and ultimately executing and adjusting the finished language as necessary.
(L.A.) I garnered a rounder, fuller sense of myself as both a physician and writer, and the intersections between the two. There is significant crosstalk between taking care of patients and sharpening my poetic voice. Having a serious artistic craft helps me maintain a practice of self-exploration and self-betterment, which interacts with but is also separate from residency training.
Conclusion
What stands out in these reflections is that students were receptive to and benefitted from a high level of craft instruction. Form, white-space, and line break are tools of the contemporary poet, and students were eager to improve their capacities to write well. This was not an “art-and-crafts” activity to help students feel better. Rather, the students responded to serious training in poetry as might be delivered in a MFA program.
Although a six-week course is brief, students brought their “whole selves” to the task, risked sharing aspects of themselves with fellow students, and found deeper ways of connecting to one another. They learned how to embrace tension, how to become more self-reflective and accept criticism, all aspects of taking oneself seriously as a writer.
Students also reported that an awareness of their creative thinking was, in fact, carried forward. Perhaps because both this course and the Narrative Medicine curriculum are offset by a compendious and intense curriculum of knowledge and skill acquisition, the impact of this type of training is, by contrast, intensified.
Ultimately, medical schools exist to train physicians, and the ways in which this curriculum shapes students’ concepts of themselves as physicians are paramount. Students note that while illness and death may become commonplace to the physician, their poetic eyes allow them to see these experiences freshly as “firsts” in their patients’ lives. The capacity for “transfiguring attention,” central to a patient’s experience of being understood, requires training and support. An arts involvement primes this skill, fostering the processes of self-awareness and self-evaluation that allow physicians to bring their most responsive selves to patient encounters.
References
Charon R, Hermann N, Devlin MJ. Close reading and creative writing in clinical education: Teaching attention, representation, and affliation. Academic Med. 2016; 91: 345–350.
Charon R, Williams P, eds. Special Theme Issue: The humanities and medical education. Academic Med. 1995; 70:758-813.
Cunningham H, Taylor D, Desai U, Quiah S, Kaplan B, Fei L, Catallozzi M, Richards B, Balmer D, Charon C. Looking Back to Move Forward: First-Year Medical Students’ Meta-Re ections on Their Narrative Portfolio Writings. Academic Med. 2018, June. 2018; 93(6):888–894.
Devlin MJ, Richards BF, Cunningham H, Desai U, Lewis O, Mutnick A, Nidiry MAJ, Saha P, Charon R. Where Does the Circle End? Representation as a Critical Aspect of Reflection in Teaching Social and Behavioral Sciences in Medicine. Academic Psychiatry. 2015 December; 39(6): 669-677
Lewis O. Reflections on Teaching Poetry to Medical Students. British Medical Journal/Medical Humanities, Film & Media Blog, Oct 12, 2023
Lewis O, Jetté A. On Teaching Poetry to Medical Students: A Conversation. Journal of Creative Writing Studies. 2023 (in press)
Lewis O, Spencer S, Schillace B. The Power of Poetry. British Medical Journal/Medical Humanities, BMJ Talk Medicine podcast. 12 September 2019.
Lucas Axiotakis is an Otolaryngology-Head and Neck Surgery resident at NewYork-Presbyterian and a graduate of Columbia University Vagelos College of Physicians and Surgeons.
Kensington Cochran is a second year medical student at Columbia University Vagelos College of Physicians and Surgeons. Her research focuses on community health initiatives, health system improvement, and digital health innovation. She received a B.A. in Neuroscience and Art History from Dartmouth College.
Jude Okonkwo is a third year medical student at Columbia University Vagelos College of Physicians and Surgeons and a graduate of Harvard College. He was selected as the 2020 recipient of the Charles Edmund Horman Prize and the 2021 recipient of the Edgar Eager Memorial FuHEnd Prize for his writing. His work has been published in Pleiades, JAMA Poetry and Medicine, and Flash Fiction Magazine, among other journals.
Conor Rork is a second-year medical student at Columbia university Vagelos College of Physicians and Surgeons. He previously studied at Rice University, graduating with dual majors in Classical Studies and Neuroscience and a minor in Medical Humanities.
Owen Lewis, Clinical Professor of Psychiatry in Medical Humanities and Ethics at Columbia University Vagelos College of Physicians and Surgeons, is the author of three poetry collections and two pamphlets. He is the recipient of The 2023 Guernsey International Poetry Prize, The 2023 Rumi Prize for Poetry, and a past winner of The Hippocrates International Prize for Poetry and Medicine.