“What's Important to You?”: The Use of Narratives To Promote Self-Reflection and To Understand the Experiences of Medical Residents

• Internship and residency
• Writing
• Primary health care
• Curriculum
• Knowledge, attitudes, practice

Too often we hear housestaff speak of residency training as a “test of survival”—getting through the next 3 years so that they may get on with their “real” careers. However, we as faculty physicians know that these years of training are not lived in a vacuum but are inextricably interwoven into the fabric of residents' personal and professional lives. Their experiences—both the highs and the lows—will profoundly influence them as future physicians. For example, when a resident attends to a patient who is dying, how he or she processes that experience will bear markedly on how that resident will react to similar situations once in practice. Yet, too little is known about the residency years.

One way to understand the influence of housestaff training on physicians is through narrative accounts of their experiences (1-3). At our institution, we used narratives to track a group of housestaff through 3 years of training (4-6). Their writings have a spontaneity and genuine honesty that captivate the reader. Such narratives provided us with an understanding of the interplay among residents' interactions with patients, their own personal issues, and their struggles during several discrete stages of their professional development. One goal of these exercises was to encourage trainees to become self-reflective (7-10). We believe that such a practice can become a consistent part of one's daily routine and allow residents to realize that they bring their whole selves—their physical beings, their emotions, their strengths and weaknesses—into each encounter. This will facilitate better understanding into why each physician reacts to patients in ways that influence those relationships and outcomes of care (11-16).

Our primary care residents rotated en bloc during their 3 primary care months each year; they spent the other 9 months as part of the larger internal medicine training program. …