Learning to grasp the emotional dimensions of clinical practice and their powerful meaning. A study on how medical students’ report patients’ grief in their reflective writings

This study refers to an educational task set for medical students at the University of Milan, San Paolo Teaching Hospital. In the second year, they are asked to gather the story of a patient’s illness and later develop this into a piece of reflective writing. The process consists of two phases: initially, students write the patient’s story in first person; then they re-write the story in third person and upload it to their personal e-portfolio. This experience is included in a module named “Writing for Reading” (WfR), which is a preparation for the Internal Medicine Course, to be completed in their fifth and sixth year. Rewriting the patient’s story in the first person has been considered a form of creative writing by Celia Hunt. This is intended to be a powerful exercise for students/professionals, which allows them to look at the patient from their perspective and, meanwhile, to identify themselves in the patient’s experience, as proposed by Gillie Bolton. Identification plays a vital role in art and literature. As suggested by Freud, and later by Melanie Klein, literature is based on a creative activity that generates characters, in which a reader can identify himself/herself. Through this process, the author can satisfy his/her needs or, conversely, control his/her resistances. Identification, as stated by Freud, is a complex process that ranges from imitation to the ability to understand the experiences of others, from their perspective. The latter is considered pivotal in the development of empathy. This study, based on the 101 reflective writings loaded in the e-portfolio during the A.Y. 2015-2016, examined whether, and how, students write about patients’ grief. Grief and loss often characterize the experience of illness, and doctors have to face these crucial aspects repeatedly. Four macro-categories emerged from the students’ writings: A. Understanding patients’ grief and expressing one’s own emotions in response to it (26 labels); B. Perceiving patients’ resilience and their capacity to activate internal and external resources to cope with their grief (12 labels); C. Feeling inadequate or resigned when facing patients’ grief: students felt unable to entirely grasp patients’ sorrow and pointed out the complexity of gathering an illness experience (11 labels). D. Perceiving the necessity of a certain detachment between patient and medical student (2 labels). Thanks to creative and reflective writing, students learned to confront patients’ grief personally, revealing, in some cases, their own emotional responses to that grief. They also discovered that patients experiencing grief can be resilient through activating internal or external resources. As in other studies analysing preclinical medical students’ reflective writings, we found a sense of inadequacy when dealing with the task of facing another’s grief. Nevertheless, students showed a defensive attitude only in two cases, when they declared that it would be better to maintain a certain detachment to patient’s grief. In conclusion, educating medical students to sustain patients’ grief is one of the most difficult challenges in contemporary medicine, and creative/reflective writing can play an important role in this process. Professional practices are shaped by earlier, biographical encounters with education, and this type of training can make a difference.