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The newspaper of The Johns Hopkins University November 17, 2008 | Vol. 38 No. 12
Practicing Empathy: A Writing Class for Medical Students

Jeff Tosoian and Melanie McNally listen to Aaron Bobb.
Photo by Jay VanRensselaer / HIPS

By Greg Rienzi
The Gazette

In a recent session of Practicing Empathy: A Reflective Writing Seminar, a second-year medical student reads aloud an excerpt of his essay detailing his aunt's fight with cancer, a battle she would not win.

The story mentions how the student's family was ill-equipped to deal with the loved one's illness, and of their inability to talk about it openly.

Eric Bass, a professor in General Internal Medicine at the School of Medicine and faculty adviser for the Practicing Empathy seminar, said it's moments like this in the workshop when he feels obliged to comment.

"I told him what he is observing in his own family situation happens to most families when someone is diagnosed with cancer," Bass said. "I said it's valuable as a physician to be sensitive to those things and provide more support to the family in those circumstances."

Bass said that the message applied to all 11 medical students in the workshop seminar, an elective portion of the School of Medicine's Patient, Physician and Society course.

Practicing Empathy premiered in 2006 and was the brainchild of Monique Tello, then a fellow in General Internal Medicine. Tello knew of similar courses at other medical schools, notably Yale, and wanted to offer Johns Hopkins students a similar reflective writing experience.

Tello asked Wayne Biddle, a visiting associate professor in the Krieger School's Writing Seminars, to lead the workshop, which he has done for its first three years.

Biddle, who has been teaching courses in nonfiction at Johns Hopkins since 1998, is the author of four books of nonfiction, as well as hundreds of articles that have appeared in American and European newspapers and magazines. His reporting on the "Star Wars" anti-missile system for The New York Times won a Pulitzer Prize.

The workshop, offered each fall since 2006, has been funded by a grant from the Osler Center for Clinical Excellence at Johns Hopkins, an initiative that seeks to train physicians in the basic elements of a sound doctor-patient relationship.

The students meet once a week for a four-week period. Each session lasts two hours.

They are required to bring with them to the first session a 1,500-word essay involving a patient care or personal medical experience. It can be about a family member's illness, an experience at a clinic or any medical-related situation that has had an impact on them.

The students are encouraged to reflect on several aspects of the experience. Each person's story gets workshopped, and he or she is allowed to revise it once before final submission.

When Tello finished her fellowship last year and took a position at Harvard, she handed over leadership of the course to Bass and Rachel Levine, an assistant professor in General Internal Medicine.

Biddle focuses on the writing, while Bass and Levine try to bring out the clinical relevance and insight contained in the stories.

Bass said that the sessions can get very emotional.

"[The students] probe more deeply into their thoughts and feelings than they normally would," he said. "It gets very personal. I think the workshops bring out a level of discussion that is quite rare in medical training. The vast majority of what medical students do is memorizing and mastering a huge body of knowledge, and they have little time to talk about the human side of health care."

The students come out of the workshop better equipped to deal with patients, Bass said, and know each other a little better.

They also leave as better writers, Biddle said.

"They have all been very good. In my 10 years teaching in the Writing Seminars, these students are some of my best," Biddle said. "They are smart, and they have a subject; that makes all the difference. That is why I'm so happy to be doing this and to work with them."

One student's essay was published in the December 2007 edition of the Annals of Internal Medicine journal. The story, written by Adrienne Shapiro, was titled "An Uneasy Understanding" and talked about her experience in an obstetrics clinic when a doctor had to inform a couple that its unborn child had a severe abnormality, a hole in the skull through which part of the brain had protruded.

She wrote: "All of a sudden, 'encephalocele' was no longer a clinical term in a fat, dry text; it meant saying 'your baby will probably die' to expectant parents."

Shapiro's essay detailed the pain inherent in delivering such devastating news, and how she was able to learn from the experience. Her essay concluded: "But to my patients yet to come, I will be able to offer the benefits of what I was given in that room. The costs of today will be repaid again and again, when future sorrows are lessened by what I have learned."

Bass said that having students come to these all-too-human realizations makes the workshops worthwhile, and are all the reason to keep the seminar going into the foreseeable future.


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