A CLOSE READING OF CREATIVE WRITING IN SCOPE, THE MEDICAL SCHOOL LITERARY MAGAZINE AT SOUTHERN ILLINOIS UNIVERSITY SCHOOL OF MEDICINE __________________________________________________ A Dissertation Presented to The Faculty of the Curry School of Education University of Virginia __________________________________________________ In Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy __________________________________________________ by Heather Anne Burns, M.F.A., M.A. December 2015 iv © Heather Anne Burns All Rights Reserved December 2015 iv ABSTRACT A growing body of literature examines the link between medical students and creative writing. It focuses mostly on reflective writing seminars with specific objectives in mind. There has been nothing found in the literature that examines medical student creative writing for its own sake. This dissertation looked at medically related creative writing contributed to a medical school literary magazine in Illinois from 1994-2013. Using literary analysis and coding for medical humanities attributes (Gold Foundation I.E.C.A.R.E.S.), this dissertation’s study assessed the ratio of medically related works to non-medically related works, identified kinds of magazine contributors, and determined incidence of medically related topics. It also provided a close reading of several pieces in relation to medical humanities attributes. It is hoped that this study will open further avenues for looking at creative writing as an important tool in medical education. iv ACKNOWLEDGEMENTS I am grateful for the oversight my advisor provided through the stages of completing this dissertation and for the enthusiasm and encouragement of my dissertation committee. I could not have completed this work without the guidance and support of faculty and staff at the Curry School of Education, the Office of the Dean of Students, and the Office of the University Provost. I am also grateful for the enthusiastic support of my family and friends. iv TABLE OF CONTENTS ACKNOWLEDGEMENTS ........................................................................................... iv LIST OF TABLES ......................................................................................................... vi CHAPTER 1. INTRODUCTION AND OVERVIEW OF THE STUDY ........................... 1 2. REVIEW OF THE LITERATURE .............................................................. 8 3. METHODOLOGY ..................................................................................... 30 4. QUANTITATIVE RESULTS .................................................................... 43 5. QUALITATIVE RESULTS ...................................................................... 56 6. DISCUSSION & CONCLUSION ............................................................ 106 REFERENCES ........................................................................................................... 118 APPENDIX A: TABLES ........................................................................................... 125 APPENDIX B: SOURCE DOCUMENTS ................................................................ 138 v LIST OF TABLES (NB: Tables designated by a number and an “a” are in Appendix A) 1. SCOPE Preliminary Findings A ...................................................................... 41 2. SCOPE Preliminary Findings B ....................................................................... 42 3. SCOPE Years, Pages, and Genres ................................................................... 43 3.a SCOPE Years, Pages, and Genres .................................................................. 124 4. SCOPE Years, Genres, and Medically Related Pieces per Genre ................... 45 4.a SCOPE Years, Genres, and Medically Related Pieces per Genre ................. 125 5. SCOPE Years and Contributor Type ................................................................ 46 5.a SCOPE Years and Contributor Type .............................................................. 126 6. SCOPE Years, Medically Related Prose and Poetry Pieces, and Topics ......... 48 6.a SCOPE Years, Medically Related Prose and Poetry Pieces, and Topics ....... 127 7. SCOPE Topic, Incidence, Years, and Genres ................................................... 51 8. Summary of Medical Humanism Attributes in SCOPE Sample ................... 103 9. Cross Analysis of Medical Humanism Attributes from SCOPE Sample ....... 110 10. SCOPE Year, Title, Genre, Topic, and Contributor Type .............................. 130 11. Sample Quotes from SCOPE Characterizing Medical Humanism Attributes 137 vi CHAPTER 1 INTRODUCTION AND OVERVIEW OF THE STUDY Since the late 1980s and early 1990s, seminars and courses in the medical humanities designed to reflect on the art of medicine have been formally included in the medical school curriculum. Assignments generally include reflective and creative writing. Many medical schools in the country have such courses and programs. They are one visible way which the medical school curriculum has developed to meet the need of improving the doctor-patient relationship and fostering the critical element of empathy within professional training (Marcus, 1999). Class titles such as Art and Medicine, History of Medicine, or Literature and Medicine involve a substantial amount of writing from the students and rely on small group sharing. Beginning in the late 1990s and early 2000s, pilot classes on poetry writing and illness narratives in such schools as the University of California, Irvine and Columbia University College of Physicians and Surgeons showed that participating student response was positive and that the writing assignments were therapeutic and helpful for teaching students about empathetic relationships with patients (Shapiro & Rucker, 2003; DasGupta & Charon, 2004). While medical students may encounter some general sensitivity training in medical school, lessons on specific topics such as the doctor-patient relationship are not emphasized in the traditional curriculum. Scholars argue that little is done in the traditional curriculum to foster empathy and compassion because starting in the cadaver 1 lab, every effort is made to foster and reward the disembodied scientific and analytical mind (Shapiro et al, 2009). Problems can result later and lead to clinicians who are perceived as uncaring and unworthy of patients’ trust. Too often, patients and families complain that the doctor-patient relationship is missing the human element of compassionate connection. Studies show that humanistic training is critical to develop medical students’ professionalism which can assist in favorable patient outcomes (Hatem & Ferrara, 2001; Stepien & Baernstein, 2006; Chen, et al, 2007; Stratton, Saunders, & Elam, 2008; Karnieli-Miller, et al, 2010). The ability to understand and communicate the emotions and feelings of fellow human beings is an attribute most people have to varying degrees. In early development, humans demonstrate empathy in our ability to imitate facial expressions and vocal tones. As we grow cognitively and emotionally, we are able to understand more complex situations and our ability to empathize can be trained (O’Malley, 1999; Marcus, 1999). In terms of health care, while one may not expect the physician to know the exact pains of one’s illness, one hopes that he knows what it is like to be in pain and endure suffering and appreciates that sometimes decisions are difficult. Literature and humanities courses with a creative writing component have helped students better understand the patient’s perspective. Research Questions. One alternative for assisting students to foster more creativity and compassionate understanding as they grow in medical professionalism could be through the medical school literary magazine rather than through medical humanities courses. This study 2 investigates the contents of one such journal and shows how medical humanism themes are interspersed throughout the volumes. An interview with the Director of the Program in Humanities and Medicine at the University of Virginia shows that student writing from medical humanities courses is important to some people in the medical school community (personal interview, 2010). Instigated and encouraged by supportive faculty over fifteen years ago, a student literary magazine called VERITAS was developed at UVA and became a strong student-driven project. There are a handful of other types of medical student literary magazines in the country. Medical student writing is a relatively unexplored topic, but interest in it is growing (Shapiro, 2009). We see from the literature that some professors request writing from their students, quite often in the clerkship year (Rucker & Shapiro, 2003, Charon, 2006; Jones, Cohn, & Shapiro, 2012). But what about writing that is not connected to a class, rather, is writing for its own sake? Could such writing assist in developing and conveying the necessary attributes of medical humanism that are deemed important for the profession (Cohen, 2007)? This research looks at one small literary magazine called SCOPE from the University of Southern Illinois School of Medicine and answers these specific questions: • To what extent and how does creative writing in SCOPE reflect the medical humanities attributes of empathy, compassion, integrity, respect, altruism, excellence, and service? To help answer this larger question, I address these specific questions: 3 • In what ways do authors in SCOPE articulate their relationship to