‘Things we are expected to just do and deal with’: Using the medical humanities to encourage reflection on vulnerability and nurture clinical skills, collegiality, compassion, and self-care

Program duration

6 weeks to align with the length of the student’s clinical placement

Tutorial frequency

Weekly

Tutorial duration

2‑hour tutorial, final tutorial 2 ½ hrs

Students

Third-year students in a graduate medical program undertaking clinical placements in geriatric medicine, palliative care, rehabilitation medicine, and refugee health

Tutors

Generalist clinicians working in different clinical workplaces to the students’ clinical placements and not directly involved in students’ clinical assessment. This assists in minimising power-differentials and fostering an open tutorial environment

Number of students

6–9 students per tutorial group, one tutor per group

First tutorial

Includes introductions and formulation of group rules. The tutor leads all tasks in the first tutorial. This helps students understand the tutor’s expectations for the task and allows tutors to bring their patients, challenges, and reflections into the tutorial space which helps establish safety and models vulnerability and openness

Check-in, debrief

Each tutorial provides protected time for students and tutors to bring interesting observations, challenges, or concerns from their week of clinical placement or work for sharing in the tutorial space

Rostered tasks^a

Description

Tutorial opening

Tutorials open with a general reflection of the previous week or if the group desires, a guided mindful meditation chosen by the person rostered to lead the task (max. 5 min )

Lead for question of the week discussion

Each week a question is provided for discussion. For example:

What forms of vulnerability do you find difficult to be near? How can you care for yourself when you are near that form of vulnerability?

Lead for book reading

Published reflections written by doctors or excerpts from such reflections, e.g. ‘Perspectives’ from the New England Journal of Medicine, Kitchen Table Wisdom by Rachel Remen, excerpts from a range of novels written by doctors

Lead for ethical scenario discussion

Short ethical scenarios are provided focusing on professional boundaries, microaggressions and threats to professionalism

Lead for understanding the person discussion

Students summarise and reflect on their experience of conducting an in-depth interview with a patient in preparation for the tutorial. In this interview students aim to understand the person through exploring current circumstances, important life events, values, beliefs, what provides meaning, healthcare experiences, impact of illness on the patient and loved ones, and social and structural determinants of health. The student usually needs to meet with the patient several times and is careful to only discuss content the patient is comfortable discussing. Permission is sought from the patient to share their story within the tutorial group

Tutorial closure

The tutorial closes with the rostered member of the group sharing an image or text from the humanities or creative arts that is meaningful to them or connects with their experiences in the previous week

Creative-reflective contribution

During the 6 weeks of the program, group members (including the tutor) draw on their reflective, analytical, or creative skills and talents (particularly those they may have neglected due to their studies or work) to develop an individual reflective contribution. A wide range of media can be used, for example, poetry, short story, visual arts (drawing, painting, sculpture, craftwork, photograph/montage, collage etc.), creative short film, music composition/performance, game design and dramatic performance or experiences of cooking, physical pursuits, or gaming. In the final tutorial this creative work is shared with the group. The sharing must not exceed 5 min but must include an explanation of how the work articulates and reflects what vulnerability means to them