title: Reflective Writing for Medical Students on the Surgical Clerkship: Oxymoron or Antidote?
abstract: OBJECTIVE
  Reflective writing has emerged as a solution to declining empathy during clinical training. However, the role for reflective writing has not been studied in a surgical setting. The aim of this proof-of-concept study was to assess receptivity to a reflective-writing intervention among third-year medical students on their surgical clerkship.
  
  
  METHODS
  The reflective-writing intervention was a 1-hour, peer-facilitated writing workshop. This study employed a pre-post-intervention design. Subjects were surveyed on their experience 4 weeks before participation in the intervention and immediately afterwards. Surveys assessed student receptivity to reflective writing as well as self-perceived empathy, writing habits, and communication behaviors using a Likert-response scale. Quantitative responses were analyzed using paired t tests and linear regression. Qualitative responses were analyzed using an iterative consensus model.
  
  
  METHODS
  Yale-New Haven hospital, a tertiary care academic center.
  
  
  METHODS
  All medical students of Yale School of Medicine, rotating on their surgical clerkship during a 9-month period (74 in total) were eligible. In all, 25 students completed this study.
  
  
  RESULTS
  The proportion of students desiring more opportunities for reflective writing increased from 32%-64%. The proportion of students receptive to a mandatory writing workshop increased from 16%-40%. These differences were both significant (p = 0.003 and p = 0.001). In all, 88% of students also reported new insight as a result of the workshop. In total, 39% of students reported a more positive impression of the surgical profession after participation.
  
  
  CONCLUSIONS
  Overall, the workshop was well-received by students and improved student attitudes toward reflective writing and the surgical profession. Larger studies are required to validate the effect of this workshop on objective empathy measures. This study demonstrates how reflective writing can be incorporated into a presurgical curriculum.
authors.affiliation: Department of Surgery, Yale School of Medicine, New Haven, Connecticut. Electronic address: gzliu@partners.org.
authors.forename: Geoffrey Z
authors.initials: GZ
authors.lastname: Liu
authors.affiliation: Department of Surgery, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Oliver K
authors.initials: OK
authors.lastname: Jawitz
authors.affiliation: Department of Surgery, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Daniel
authors.initials: D
authors.lastname: Zheng
authors.affiliation: Department of Surgery, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Gusberg
authors.affiliation: Department of Surgery, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Kim
mesh_terms: D000046:Academic Medical Centers; D002982:Clinical Clerkship; D004504:Education, Medical, Undergraduate; D004645:Empathy; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D008297:Male; D013337:Students, Medical; D014956:Writing
keywords: Interpersonal and Communication Skills; Patient Care; Practice-Based Learning and Improvement; Professionalism; empathy; narrative medicine; reflective writing