Creative Writing and Medical Education

Dr. P. Ravi Shankar Department of Medical Education KIST Medical College Lalitpur, (Nepal).

There can be a number of advantages of familiarity with and skill in creative writing, to medical educators. In the article, the author briefly reviews the initiatives in creative writing and medical education and describes how creative writing has helped him become a better medical educator. The article ends with possible advantages of creative writing to medical educators.

I am a clinical pharmacologist and a medical educator. At present, I work at the KIST Medical College, Imadol, Lalitpur, a new medical school in the Kathmandu valley. I am keenly interested in promoting more rational use of medicines and training medical students to use essential medicines rationally. My research interests are small group, activity-based teaching, Pharmacoepidemiology, Pharmacovigilance and Pharmaceutical care services among others.

I am also a keen trekker and often trek in the mountains of Nepal. I am interested in photography and a SLR camera is a constant feature during my treks. Creative writing is one of my passions and I write essays, short stories, poems and travelogues. I have written short stories during my school and college days which have been published in various school and college magazines. I also write travelogues for various newspapers and magazines. My poems have been published in international medical journals like the Canadian Medical Association Journal (CMAJ) and the Croatian Medical Journal (CMJ). Articles dealing with non-medical topics and medical issues from a non-medical viewpoint have also been published. An article describing my experience of conducting high altitude research in the Himalayas was published recently in the Journal of Clinical and Diagnostic Research (JCDR) (1). I write on medical issues targeted at a general audience for Nepalese newspapers and magazines.

In this article, I plan to briefly review creative writing and medical education programs and explore how creative writing has helped me to be a more effective medical educator and to look at possible relationships between creative writing and medical education.

Creative Writing and Medical Education
Narrative approaches to medical education are becoming important in the United States (US), the United Kingdom (UK) and also in other countries (2). In Australia, training in creative writing was offered to general practitioners (GPs) and medical educators by the North Coast GP Training and Southern Cross University (2). In general, the respondents were very much satisfied with the workshops. The participants felt that they could write about problems faced by them during their practice and share their experiences with others. The workshop gave them a fresh view on their profession (2). Intuition is a decision making process used by experienced practitioners and uses clinical hunches for diagnosis and decision making. Intuitive powers can be improved by creative writing and dialogues with professional colleagues (3). The author recommends that it is time to revive and celebrate clinical story telling as a method of professional development. An author has looked in detail at various western medical men who were also writers over the ages (4). The compilation makes for interesting reading and among the many names were Sir Thomas Browne, Locke, Holmes, John Brown, Osler, Oliver Goldsmith, John Keats, Anton Chekov and Arthur Conan Doyle.

An intensive writing workshop was held for Internal Medicine residents in a medical school in the United States (US). The workshop served as a creative outlet from the rigors of medicine, created a sense of community among the participants and increased self-awareness and awareness about the patient’s lives (5). The authors suggest that teaching creative writing may deepen the interaction with peers and patients, improve writing skills and increase interest in writing and the residency program. Non-medical writing by surgeons is usually in the form of creative non fiction on moving and emotionally charged situations or experiences with individual patients (6). The author states that such writing is creative and cathartic for neurosurgeons and can help to educate patients. Creative writing can be used for reflection into patient care and social and other perspectives of medicine. The authors of a recent article listed two phases in creative writing (7). In the first phase, the author sits alone and introspects into various aspects of medical practice. This helps him/her reclaim a personal voice, identify the patients’ voice, balance contrasting perspectives and respond to the emotional aspect of patient care (7). The second phase of reading and group discussion is communal and acknowledges vulnerability, risk taking and self-disclosure. Professional development, patient care and the wellbeing of practitioners can be improved through creative and reflective writing.

An expert in creative writing believes that literary texts offer doctors a chance to let in the life world of their patients and that the acts of reading and healing are intertwined (8). Literature assists doctors to connect to the world of their patients and develops empathy and the habit of reflection among them (8). In a recent article, an author described how medical charts only cover a very narrow dimension of the doctor-patient encounter (9). Emotions, doubts and uncertainties on the part of both patients and the doctors are not described in the medical chart. Medical Humanities uses disciplines traditionally known as the arts (humanities) like literature, arts, creative writing, drama, film, music etc. in pursuit of medical educational goals (10). Literature can enrich the thought processes of doctors and provide a wealth of concepts. They can develop the doctor’s moral sense, increase empathy and compassion and even increase clinical acumen.11 The practice of medicine in other times and in other locations can be understood and the habit of reflection among doctors promoted (12). Medical Humanities programs are at present conducted in many countries all over the world. The University of California, Irvine, College of Medicine started a literature and medicine elective in 1997 (13). The program emphasizes a small-group interdisciplinary learning and the learners use creative projects to reflect on patients and themselves (13). In Nova Scotia, Canadian medical humanities include medical history, literature, music, art, multiculturalism, philosophy, epistemology, writing, story telling, health law and ethics, offering a very broad concept of the subject (14).

Creative and Scientific Writing
These days, publication and research are becoming important for medical teachers even in Nepal and an obvious link can be made between creative writing and scientific writing and research. Creative writing has helped me in visualizing more clearly what I plan to write and in linking ideas, concepts and sentences together to form a coherent whole. I find it easier to think and write clearly, concisely and coherently as compared to many of my colleagues. Also, I do most of my creative writing in English and familiarity with the language helps me in scientific writing and in ensuring that what I write makes sense.

Creative Writing and Constructing a Clinical Scenario
I and my colleagues had conducted problem-stimulated small group learning sessions in Pharmacology at the Manipal College of Medical Sciences (MCOMS), Pokhara, Nepal (15),(16) and continue to use the same teaching-learning methodology at KIST Medical College (KISTMC), Lalitpur. A clinical problem or scenario is used to guide student learning. The clinical problem or scenario sets the boundaries of and guides student learning. I believe that the scenarios should be relevant to the context of Nepal and should introduce students to Pharmacology and Pharmacotherapeutics in a Nepalese context. I and my colleagues have been constructing and using these scenarios for over six years now. With a background in creative writing, I find constructing interesting scenarios and problems which reflect drug use in a Nepalese context easier and the scenarios read better and reflect the ground realties.

Adding Interest
I share with students, photographs of various areas that I have trekked in and interesting experiences during my lecture classes and other presentations. I believe that the judicious use of these photographs makes my presentations more interesting. In both MCOMS and KISTMC, the students bring out a wall magazine periodically and also a yearly magazine. I am a frequent contributor of articles along with photographs to both types of magazines. I believe I have been reasonably successful in creating interest among students about the wonderful mountain regions of Nepal. At MCOMS, students had accompanied me and other faculty members on treks during holidays and had a wonderful time exploring nature in all its glory.

Mountain Medicine Society of Nepal
Students, mainly from the Institute of Medicine (IoM), with a few others from other medical schools, have started the Mountain Medicine Society of Nepal (MMSN). Members spend time doing various research projects in the Himalayas and also volunteering at two aid posts set up by the Himalayan Rescue Association at Pheriche in the Everest region and Manang in the Annapurna region. I have been lucky to have participated in two research projects and am able to share with students, my experience of teaching trekkers about various illnesses associated with altitude and of treating those who developed problems in the remote region. MMSN also publishes a Newsletter and I frequently contribute. MMSN is a wonderful concept where Nepalese medical students gain experience in working in remote areas, at high altitude, do research and also enjoy themselves. I think the society should have branches in all the medical schools of the country.

Medical Humanities
Since the last two years, I have been keenly interested in the Medical Humanities and the interrelationship between art and medicine. I had conducted a voluntary module for medical students at MCOMS (17) and am presently conducting a module for first year medical students at KISTMC. We have been trying our best to make learning interesting and fun. Case scenarios, group activities, role plays, paintings, music, debates and brain storming sessions have been used to explore various aspects of the Medical Humanities. I have found my creative writing skills useful in constructing interesting and informative case scenarios, in selecting paintings and in planning the activities. At MCOMS, I had used literature excerpts in the MH module and my familiarity with creative writing was useful in selecting excerpts.

Familiarity with creative writing also helps the teacher use newer and more creative methods of teaching-learning. At MCOMS, we had mainly concentrated on problem-stimulated learning in the practical class. At KISTMC, we are also trying to make large group teaching more interesting and interactive. Student activities, questions and student feedback are all being used in structured large group sessions.

Thus familiarity with and exposure to creative writing may be of help to medical educators in a number of ways. (Table/Fig 1) describes this in detail.

My familiarity with creative writing was of great help to me in writing research papers, constructing scenarios for problem-stimulated sessions in Clinical pharmacology, using photographs and personal experiences to make presentations more interesting, involving in and writing about the various activities of the Mountain Medicine Society of Nepal (MMSN) and in designing and conducting a Medical Humanities module for medical students in Nepal. Thus, creative writing has helped me in many aspects of medical education and has helped me become a more effective medical educator. I think the link between creative writing, extracurricular pursuits and medical education is interesting and other medical educators should share their experiences on this topic.