Program

In the fall of 2008, Ann Broderick, MD, from the Carver College of Medicine and Patrick Dolan, PhD, from the University of Iowa's Rhetoric Department, offered a course titled Rhetorical Issues in Health Care: Hospice, Rhetoric and End-of-Life. The course combined service learning at Iowa City Hospice, a non-profit, volunteer intensive, community-based hospice, with readings illustrating the rhetoric surrounding end-of-life from Plato to Timothy Quill. The students underwent hospice training, did twenty-five hours of service, discussed their experiences and their reading in class, and wrote a seminar paper.

The course aimed to be interdisciplinary. One of the teachers directs the Palliative Care Program at the University of Iowa Hospitals and Clinics, while the other, a hospice volunteer, studies literature, rhetoric and end of life. The students included a medical student, a nursing student, a student in Aging Studies, and a pre-med student. Discussions ranged from medical issues, to psychosocial dimensions of care-giving, chronic illness, death and bereavement to ethics. The course offered the students wide latitude in their choice of topics and approaches.

The presentation will be a panel discussion in which the instructors will explain their aims and methods during the course, and the students will offer comments on their experiences.

Background: The use of reflective narrative writing to augment reflective practice instruction is well documented. We propose that interactive reflective writing (with faculty feedback) can support students and foster professional development.

Objectives: To support a reflective writing curriculum with a guide for students and faculty and an analysis and evaluation framework.

Setting: At the Warren Alpert Medical School of Brown University (Alpert Med), a curriculum of students' reflective writing (20-25 structured "field notes" are required within the first two pre-clinical years) with guided individualized feedback from an interdisciplinary faculty team has been implemented in a Doctoring course since 2005-6.

Methods: A tool to guide faculty in crafting quality feedback, i.e., the Brown Educational Guide to Analysis of Narrative (BEGAN), ideally geared toward promoting the students' educational process, was developed and applied by the authors. The multi-step BEGAN framework guides faculty to identify salient student quotes from the students' text and illuminate students' insights, utilize reflection-inviting questions, highlight derived lessons/key concepts (using faculty's clinical/personal experience), extract clinical patterns, and provide concrete recommendations as relevant. Recently, an evaluation rubric for identifying student reflective level and its development over time has been developed as well.

Results: The guides have been offered to the students and faculty for the present academic year and the rubric will be applied to 90 second year "best notes" during March 2009.

Conclusions: Within this conference presentation, we will describe the BEGAN and rubric, provide examples, and report the results of the first rubric application.

Many physicians express a desire to write creatively, but most never do. On the surface, physicians should make natural writers: they hear lots of stories, are exposed to a wide range of life experiences through their work and through their patients, and they are used to feeling empowered to accomplish what they set out to do.

Nevertheless, diverse barriers to writing prevent desiring physicians from starting or continuing to write. Many physicians and medical students feel very threatened at the idea of writing, don't know how to capture their thoughts and stories, have difficulty finding a narrative voice, and aren't comfortable expressing themselves on paper.

Understanding these barriers can help physicians and students recognize the issues that are pertinent for themselves and begin the process of freeing themselves to write

This presentation will begin with reflection by the audience as to their own experiences with trying to write.

Then we will discuss how personality characteristics, identity issues, work issues, and other factors also affect physicians' abilities to write creatively.

We will discuss theories about writers' block, and the group will discuss the relevance of this information for physicians in general and for themselves in particular. The session will close with further reflective work by participants to address their own barriers to pursuing writing.

A poetry interest group that will allow poets to meet each other, discuss craft, share work (both at the meeting and later on by electronic means), consider the role of poetry in medical education, and compare favorite poets--past and current. Each participant should bring a poem, his or hers or someone else's, to read to the group.

With continuous staff shift changes and patients who are shuttled between wards, hospitals risk becoming places of human disconnection. Bored patients turn to droning television programs to numb themselves to their overwhelming emotions or to block out the sounds of beeping machinery.

College students looking to volunteer in such hospitals typically end up filing papers, answering telephones, or fetching coffee. Rarely are they able to interact with patients on a level deep enough to understand patients’ stories. As a result, when undergraduates transition into medical students, they may see patients from only the prescribing side of the clipboard.

Healing Words, an organization of college students who read aloud in hospitals, allows volunteers to connect directly with patients through the bridge of literature. This activity leads to conversation that relaxes both parties and precipitates deeper levels of communication. Such exchanges hold the potential for patients to transcend their clinical settings via imagination or personal recollection. Founded by then-college sophomore Valerie Gribben, Healing Words was inspired by Gribben’s reading to her own mother, who was undergoing chemotherapy for breast cancer.

In this presentation Gribben will trace how Healing Words began and how it has grown to encompass health care facilities throughout the city of Birmingham, Alabama. She will discuss how her perspective as a teenage author influenced the development of Healing Words. Additionally, she will incorporate comments from volunteers about their experiences with the patients.

I will read two original pieces about a deceased patient, one factual and the other fictionalized, to stimulate discussion about the benefits and shortcomings of both approaches in writing about our patients' lives and legacies.

It feels as if more and more medical memoirs and personal essays fill bookshelves and the pages of medical and literary journals. And yet, this attention highlights a potentially perilous dilemma for physician/writers. Principles and moral values that guide bedside responsibilities and behavior towards patients still apply to the task of writing about them. The physician/writer is still a physician. This tension makes me uneasy.

When I write about seemingly real medical experiences, I choose fiction. Three dominant justifications justify what has up to now been an unconscious decision: respect for patient privacy, trust and potential abuse of the physician/patient relationship, and my belief that the story always comes first.

I'll discuss key ethical considerations as well as the small but growing body of literature that describes strategies for writing about medical experiences while respecting patients and clinical experiences. A vital part of this joint presentation involves a lively discussion with the audience.

While many physicians and medical students know that writing memoir can increase one's self-understanding, few realize that biographical writing holds the same potential. Investigating another person's life -- a fellow healthcare provider, a patient, or anyone -- forces writers to compare their experiences and perceptions with those of their subject. As a result, biographers often find themselves transformed by their writing. This presentation will draw from the speaker's experience as the biographer of lobotomy developer Walter Freeman, MD, as well as from biographical writings of Oliver Wendell Holmes, Sr., Lytton Strachey, Oliver Sacks, and others.

Patients at a comprehensive cancer center have participated in a weekly writing program for seven years. Anecdotal evidence following writing in this clinical setting appeared congruent with the results of expressive writing studies conducted in laboratory settings. To move expressive writing research beyond the laboratory, we evaluated the feasibility of engaging a clinical population in a structured expressive writing task while they waited for an appointment in a cancer clinic. Adult leukemia and lymphoma patients (N=71) completed a baseline assessment, 20-minute writing task, post-writing assessment, and 3-week follow-up; 88% completed the writing task and 56% completed the follow-up. Participants reported positive responses to the writing and immediately post-writing, about half (49.1 %) reported that writing resulted in changes in their thoughts about their illness, while 53.8% reported changes in their thoughts at the 3 week follow-up. Reports of changes in thoughts about illness immediately post writing were significantly associated with better physical quality of life at follow-up. Initial qualitative analyses of the texts identified themes related to positive change/transformation following a cancer diagnosis. Findings support the feasibility of conducting expressive writing with a clinical population in a non-laboratory setting. Cancer patients were receptive to expressive writing and reported changes in the way they thought about their illness following writing. These preliminary findings indicate that a single, brief writing exercise is related to cancer patients' reports of improved quality of life. Presentation includes a review of the study and the impact of its publication in The Oncologist, a peer-reviewed scientific journal.

During its forty-one years, the International Writing Program has hosted over 1200 emerging and well-established writers from more than 120 countries. They come to Iowa to write, to exchange ideas, to learn about one another and about America; and in the process we learn from them. This talk will give a brief overview of the IWP and the continuing role of the arts in 21st century cultural diplomacy, and then will focus on one of the enduring lessons presented by the visiting writers: the enormously different attitude towards specialization taken by international writers, the majority of whom write in a number of genres and maintain a professional position as a matter of course.

The aim of this presentation is to discuss the research that provides strong scientific evidence of the physical and psychological health benefits of a writing intervention: structured written emotional expression (SWEE). Based on work of James W. Pennebaker, this presentation will: a) describe the process of structuring the writing intervention; b) review major studies demonstrating SWEE's therapeutic health benefit; c) offer a conceptual model based on "meaning making" as understanding how the writing intervention affects health; and, d) report the findings of a completed NIH funded study testing the effect of emotional written expression in a population of 43 homebound family caregivers (mean age=66) of persons with Alzheimer disease and related disorders (ADRD) that were randomly assigned to either an experimental or comparison group who wrote for 20 minutes on three alternating days. Experimental group family caregivers (N=25) wrote about their deepest thoughts and feelings about caring for their loved one while those in the comparison group (N=18) wrote about non-emotional topics such as food preparation. Saliva cortisol was measured four times a day for two days at pretest, on the fourth and fifth and again at the thirtieth and thirty-first days after the last day of writing. A multi level (three levels) of analyses were performed using HLM software to test the effect of the intervention on saliva cortisol levels. The experimental group participants had significantly lower saliva cortisol levels (p=0.029) on the fourth and fifth days after writing. This is the first study to demonstrate that SWEE, a low cost, easy to administer, and innovative intervention significantly reduced saliva cortisol levels in a population of family caregivers.

The study of illness has traditionally been examined through biomedical, oral, and word-based discourse. This paper seeks to extend the study of illness by examining alternative modes of representation including still photographs, moving images, participatory arts-based media, and other forms of textual representation in order to explore how social interpretations of illness affect the ways in which people represent and understand themselves and their bodies. This paper provides an exploration of illness narrative as it relates to aspects of individual and societal transformation, roles of agency and objectification, and the act of witnessing. The role of visual images and their potential contribution to the genre of illness narrative will also be discussed. Finally, this paper will discuss the cultural phenomena of illness meaning through an analysis of the form and content of my own visual illness narrative titled This Time Nothing. This process, when considered along side traditional social and biological research methodologies, can contribute to the development of policy and organizational-level approaches that improve services within health and mental health systems.

Professionals are expected to assess their progress and direct their own learning. To develop these skills, students must learn to reflect on personal experiences. An interactive small group session entitled "Patient Stories" provides third year medical students rotating on an Inpatient Internal Medicine Clerkship with an opportunity to create a poem based on a patient's history and physical exam and allows them to reflect on their interactions with patients and on their interpersonal and communication skills.

Students choose a history and physical examination that they wrote during the rotation. After the physician facilitator introduces the session and demonstrates the process, students remove words from the document, leaving those they consider most important to their patients' stories. Students may include information from their interactions with their patients that was not recorded in the original documents. After creating their poems, students read and discuss their work in small groups. The whole group is re-convened and some students read their poems out loud. Finally, the students and facilitators discuss themes addressed by the poems.

The presenters will discuss the educational goals of "Patient Stories" and the format of this interactive session. Several students will read their poems and will share what they learned from creating their poems. Participants will have the opportunity to respond to the presentation and to discuss ways this exercise or similar exercises could be used in clinical teaching to encourage reflective practice.

In this session we will discuss form in poetry. We will start with the sonnet as an example of "normal" function, then examine free verse in terms of its deviations. While our discussion will focus on craft, we will see how elements of craft further or undermine assertions within a poem's content.

This session will be of interest to those with little background in formal prosody as well as to all poets, who will please further or question the presenter's interpretations. While the discussion will stem from a PowerPoint, I hope we will rapidly deviate from that form as well.

During a twelve hour elective course on Poetry and Medicine for second year medical students, we created a blog as a vehicle for accessing online poetry resources as well as sharing new poetry created by the students and the instructor based on prompts discussed in class. This presentation will explore the most reliable Internet resources for studying poetry and illness and poetry by physicians, and outline the success of initiating an online "operating room" for the creative writing of doctors-in-training.

We invite participants to a presentation of narrative medicine in practice: a practice that values witnessing, that promotes narrative competencies in attention, recognition and interpretation and that invites one to be moved by stories of illness. We will share our experience of developing a Narrative Oncology workshop at New York Presbyterian Hospital that includes healthcare practitioners, patients and caregivers reading and writing together. Such integration reflects the belief that a patient's voice should be central to healthcare practices. By writing about their illnesses, patients discover the story of survival, move it from "talk" to the visible page where they can recover, revise and thereby control the meaning of what has happened to them. As patients, clinicians, and caregivers narrate their experiences, the others listen attentively and respond, reflecting back to the writer what has been written. The shared experience of the writings provides common points of reference and strengthens the common fabric. We will discuss the workshop's merits-improved communication, understanding, and patient care- and the challenges of such an integrated practice, such as limits of time, space, funding and professional boundaries.

The second half of the presentation will be a short creative workshop. Participants will have the opportunity to experience the exceptional illumination that close reading and reflective writing can bestow upon one's personal or clinical experience with illness. Our workshop will include an introduction to the close reading of a short published illness narrative, reflective writing about a personal experience, followed by the collective discussion of our representations in a safe and confidential environment.

Participants are invited to meet with an acquisitions editor to discuss their book proposals. Please note that the editor will not read publishing contracts or offer legal advice. This session is intended to help sharpen and focus proposals and identify potential publishers for individual projects.

Students read from research and service-learning projects for their course, "Illness and Health in Literature," at Central College.

Stephen Lovely will read from his first novel, Irreplaceable, just published by Hyperion/Voice, and take questions.

Irreplaceable is the story of four people whose lives intersect and complicate in the aftermath of a heart transplant. The novel views organ donation as a brave, selfless, empathetic act, and explores how the rare, complex transaction of a transplant can have powerful effects not only on the recipient and donor and their families but on the person responsible for the donor's death.

Sign-up to share your fiction, essay, or poetry will be available at the registration table both Wednesday evening and Thursday morning.

In my book, A Story of Witchery, I use the fairy tale genre to create a mirror between the accepted strangeness of the fairy tale and the accepted strangeness of the medical world. The language of fairy tales and the expectation of the fabulous juxtaposes nicely with what happens to a patient in the context of western medicine. In the world of the hospital, where western scientific ideas about sterility and problem-solving rather than wellness dominate, a patient is required to accept the strange, the painful, the dehumanizing and the extreme while being exposed to a clinical language that suggests that nothing is out of the ordinary. I will present both modern and classic fairy tales and discuss their language in light of theories of their psychological value and their direct relevance and utility for individuals experiencing extremity.