Roshni Beeharry, a medical educator and Writing for Wellbeing and Personal Development facilitator, reflects on the multitude of ways creative writing practice contributes to a well-rounded healthcare education.
In 2013, I formally explored the field of creative writing in healthcare education via a systematic review of international literature, the findings of which are discussed in my article “The potentials of creative writing in healthcare education” (Beeharry 2021, 53-5). I found that creative writing can not only facilitate staff and students’ professional development, including understanding and empathising with patients, but also help staff and students understand their own narratives and those of peers, which in turn can contribute to their wellbeing and personal development.
Reflecting on and building on my ideas since that review, I propose that creative writing in this context can be viewed through a ‘kaleidoscope’ of lenses:
- Creative writing pedagogy including creative writing as a craft;
- Therapeutic writing, in particular Pennebaker’s expressive writing paradigm (Pennebaker 1997);
- Adult learning theories, including reflective practice, transformative learning and constructivist theories: for example I propose that the writing group could be considered a potential ‘zone of proximal development’, with the writing group peers and facilitator providing a ‘scaffold’ for development’ (Vygotsky 1978) and the writing workshop as a small group learning environment and potential interprofessional community of practice, as well as a form of simulation to explore personal and professional identity.
Having an insight into pedagogy allows us as educators not only to design new educational activities involving creative writing, including the assessment of them (a somewhat controversial area beyond the scope of this short article), but can also help us ‘stand our ground’ in the face of resistance and murmuring rhetoric by colleagues that the arts might be a ‘nice distraction’ or optional extra in healthcare education, but not something worth integrating or investing in, in increasingly-crammed curricula or cash-strapped health services.
Creative writing as craft vs. reflective writing model
Creative writing as a discipline has its roots in other pedagogy including composition studies and literary studies. In my systematic review, participants in groups from these disciplines produced (as a percentage of the final 26 articles analysed): prose including novels and short stories (67%), poetry (48%) and playwriting (19%). Although each have their own taught structures, there is flexibility and these structures become more implicit as the writer improves their craft. Compare this to one of the seminal models of reflective writing used across healthcare education, the Gibb’s Reflective Cycle model, which is specifically structured: Description of event – feelings – evaluation – analysis – conclusion – action plan (Gibbs 1988). This is explicit in format, factual and certainly not imaginative in nature. For me, the creating and building up of a story, a poem or other form of imaginative writing is a refreshing antithesis to the analytical deconstructive process of academic writing and reflective practice models. Instead, under a craft-based pedagogy, healthcare clinicians/student-writers give themselves permission to experiment and play, and to potentially discover aspects of themselves, their patients and wider society, through the process of writing.
In healthcare education, the aim of reflection is of course to improve one’s practice through practical behavioural change, and to enhance professional development. Although creative writing can be a form of reflective practice, it is important to distinguish the two, and to be mindful that there may sometimes be a blurring of the two areas in healthcare literature, as I found in my systematic review. An excellent resource is Lisa Kerr’s paper on creative writing as reflective practice in healthcare education, which gives a comprehensive appraisal of this area at the time of writing (Kerr 2010).
In both expressive and reflective writing, the process is fundamental, more so than the final product (although reflective essays, for better or worse, are often assessed in medical undergraduate education at all levels). In creative writing, the outcome or ‘product’ – the poem, prose or other piece – is the focus, existing for others to consume. However, neither reflective writing nor expressive writing are considered a craft, something that can be developed, improved and honed with practice, revision and feedback from others. That is, no emphasis is placed upon developing our views, opinions, communication skills or insight, or upon reflection by doing the writing, sharing it and integrating feedback through revision, though this has much in common with academic writing processes. In educational terms, this can be seen as a form of praxis and experiential learning. Writing involves making choices: what to include and what to leave out; using appropriate literary techniques such as metaphor, simile and imagery; tense and word choices; editing and revising. And where else does carefully choosing your words carry higher stakes than when communicating life-changing news to a patient, or persuading colleagues of a new research or educational idea?
Celia Hunt and Fiona Sampson suggest that:
Fictionalizing from ourselves and finding a satisfactory form for our fictions helps us to engage more deeply with our inner life, opening up possibilities for greater insight and self-understanding (Hunt and Sampson 1998, 33).
Patient narratives are often not linear and do not always fit neatly into the categories of the ‘medical history-taking’ format, but can be complex and multifaceted, reflecting what is true for all of us: that life itself does not follow one straight path, but is complex, and we are multifaceted beings. Fiction, particularly storytelling techniques, allows us to experiment and play with linearity, possibilities, alternative perspectives and time. Part of developing as a healthcare professional, and as a maturing adult, is reflectively and reflexively examining our own narratives and life stories, and that involves retelling our own stories, what some refer to as ‘restructuring our own narratives’.
Experimenting with the point of view of characters in a poem or piece of prose – the intimacy of first and second person point of view versus the relatively distancing third person stance – can contribute to the development of empathy and reflection in different ways. Physician Jay Baruch expresses this eloquently:
By playing with words, students begin to figure out how cutting sentences can give words room to breathe. Sometimes less is more, and readers fill the space with their own interior landscape, rife with memories, emotions, biases and preconceptions. What we say to patients, and what they tell us, is more than information. The words we choose, and the voice in which they’re delivered, contain hints to our history, values, desires and character (Baruch 2013, 468).
The reading of poetry has increased during the pandemic, as it has at other times of turmoil (Jack 2021). What is it about poetic forms that makes them appealing for expressing the complexity of emotions we face in delivering and receiving healthcare? In my view and experience, poetry can distill emotions and experiences that are otherwise difficult to articulate. Like prose, poetry can convey meaning through imagery, metaphors and other poetic devices. Perhaps it is also the fact that there is no need to add narrative or linearity, but one can merely capture and communicate an essence of the experience, that makes poetry an attractive art form to healthcare professionals as well as writers.
The importance of the ‘flow state’
Creative writing as a flow activity is an area that I feel is overlooked in the health humanities literature. In his seminal article, psychologist Mihaly Csikszentmihalyi introduces us to his concept of flow, which can be achieved, he proposed, through engaging in creative, sporting and religious activities:
The concept describes a particular kind of experience that is so engrossing and enjoyable that it becomes autotelic, that is, worth doing for its own sake even though it may have no consequence outside itself… You lose your sense of time, you’re completely enraptured, you are completely caught up in what you’re doing, and you are sort of swayed by the possibilities you see in this work… (Czikszentmihalyi 1999, 824).
This is exactly why I have enjoyed creative writing since childhood; that absorption, getting lost in time and in a world I create.
Csikszentmihalyi goes on to say:
The idea is to be so, so saturated with it that there’s no future or past, it’s just an extended present in which you are… making meaning. And dismantling meaning and remaking it (Csikszentmihalyi 1999, 825).
And isn’t making meaning of our lives and our experiences a key part of what defines us as human beings and brings us together (but also can drive us apart)? Sharing this supportively with peers and colleagues has the rich potential to foster recognition and ‘bonding’ through commonality of experience, building and nurturing communities of practice.
In a world where outcomes and assessment are a constant presence, it can be liberating to give yourself permission to create something new and imaginative, rather than purely factual, limited in its scope by virtue of truth. That is, giving yourself permission to play and have fun. Creating something from oneself – a poem, story, piece of memoir – can bring a sense of achievement and satisfaction as meaningful, for some of us more so, than any exam result.
About the author
Roshni Beeharry is a writer, poet, medical educator and Writing for Wellbeing & Personal Development Faciltiator, who designs and facilitates writing workshops for the public, staff and students in healthcare, academia and other organisations, and special study modules for medical students in Creative Writing for Personal & Professional Development. She is a former Consultant in Neurological Rehabilitation Medicine. Roshni is currently Teaching Fellow in Clinical Communication & Cultural Competence at Kings College School of Medicine, London.
References
Baruch, J.M. 2013. “Creative Writing as a Medical Instrument”. Journal of Medical Humanities 34, 459–69. https://pubmed.ncbi.nlm.nih.gov/24006190
Beeharry, Roshni. 2021. “The potential of creative writing in healthcare education”. Writing in Education 83, 54-5. https://www.nawe.co.uk/Private/133615/Live/attachment1/WiE%20Spring%202021%20online%20CONFERENCE.pdf
Csikszentmihalyi, M. 1999. “If we are so rich, why aren’t we happy?” American Psychologist 54, no. 10, 821–2.
Gibbs, G. 1988. Learning by Doing: A Guide to Teaching and Learning Methods. Oxford: Oxford Further Education Unit.
Hunt, C. and Sampson, F. (eds). 1998. The Self on the Page: Theory and Practice of Creative Writing in Personal Development. London: Jessica Kingsley Publishing.
Jack, Belinda. 2021. “Pandemic reading: poetry, looking and seeing.” The Lancet 391, 1438-9. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00831-X/fulltext
Kerr, L. 2010. “More than Words: Applying the Discipline of Literary Creative Writing to the Practice of Reflective Writing in Health Care Education”. Journal of Medical Humanities 31, 295–301. https://doi.org/10.1007/s10912-010-9120-6
Pennebaker, J. W. 1997. “Writing about emotional experiences as a therapeutic process”. Psychological Science 8, 162-6.
Vygotsky, L. S. 1978. Mind in Society: the Development of Higher Psychological Processes. Cambridge, MA: Harvard University Press.
