Becoming Zusha: Reflecting on Potential in Medical Education and Practice

By Hedy Wald

Reb Zusha* used to say: “When I die and come before the heavenly court, if they ask me, ‘Zusha, why were you not Abraham?’ I’ll say that I didn’t have Abraham’s intellectual abilities. If they say, ‘Why were you not Moses?’ I’ll say I didn’t have Moses’ leadership abilities. For every such question, I’ll have an answer. But if they say, ‘Zusha, why were you not Zusha?’ for that, I’ll have no answer.”   

*Rabbi Meshulam Zusha of Hanipol (Anipoli), pious great Hassidic Rabbi (1718-1800)

What is our answer when faced with the challenge of helping our “Zushas,” our learners and educators, be all the “Zushas” they can be?

Developing a “reflective culture” within medical schools and teaching hospitals can encourage and guide learners, educators, and practitioners to recognize and take steps toward realizing untapped potential in self and in health care teams. Within a longitudinal, developmental reflective process starting in year one of medical school, extending into residency  and beyond,1 reflection-fostered awareness of self, other, and situation facilitates purposeful, self-directed learning, more effective use of feedback, and development of new habits of mind, heart, and practice.2  Meaning is created from experience and newly illuminated capabilities may be actualized…

“Reflective culture” cultivation broadens medical education focus to include teaching metacognitive and meta-affective skills, including mindful awareness and active monitoring of one’s thinking and learning processes as well as emotions, i.e. becoming a “responsible scholar.”3 As adaptive learners,, cognizant of cognitive and affective components (what hinders? what helps?), “responsible scholars” broaden their horizons by capturing transformative learning opportunities presented by patients, colleagues, and situation/environment; challenging “him or herself to take risks, to invent and reinvent, and to take on active and lifelong inquiries”3 p. 459 resonating with critical curiosity- leading to personal/professional transformations. Guided reflection supports the lifelong process of professional identity formation (PIF).4

Hence, we are challenged to be “responsible educators” to support this process; translating theory into practice. Within  our Family Medicine clerkship, I use interactive reflective writing (IRW) to foster reflective capacity; a means of providing fertile ground for growing new ideas about oneself within the lived reality of medicine.1 And I’ve observed faculty enthusiasm for fostering their own potential (for teaching) and that of their learners while leading interprofessional faculty development IRW skill-building workshops.1 Trained “responsible educators” can foster comfort within learners’ discomfort that may arise within perspective transformation and reflect back steps they are taking to realize potential; crystallizing previously unrecognized “growth spurts.” Systematized reflection (e.g. reflective coaching within IRW, portfolios, and quality improvement1) helps learners  “hear” the collective voice within professional socialization and multiple voices ( health care teams, patients) while maintaining awareness of their singularity (which narrative conveys); the person trying to develop their potential within the lifelong PIF process.1,4 And evidence is emerging for IRW enhancing elements of resiliency1,5 to support healthy PIF and vitality/creativity.5

“In the trenches,” I’ve become a believer in the power of narrative throughout the professional life cycle to develop imaginative processes, open windows in our heads enabling seeing possibilities, and notice transformative learning opportunities en route to creating new stories for ourselves, for the physician-patient dyad, and for health care teams we work with. We wear two hats as responsible educators and scholars, as reflective role models and reflective practitioners, creating possibilities for change in our learners and in ourselves in the lifelong “becoming.” Within the unfolding story(ies), consider assumptions, multiple perspectives, and potential consequences of action in ethical dilemmas through reflective process . . . How did you stretch yourself, how could you? Can you think about your thinking to get out of the box? And how apply lessons learned to develop future action for compassionate, caring, competent practice?

I recently sat with a third year student who shared his thoughts on the value of IRW as allowing pause… a vehicle for looking at where he’d been, where he was now, and where he might go. He requested additional readings, mentioned his interest in doing more writing, and said thank you. We grasped the potential moment of developing potential – his and mine.

So the “how to” in supporting development of our potential as health care practitioners and/or educators? Cultivating continued striving to reach one’s full potential, I would suggest; taking action within a meaningful context of reflective self, other, and situational (“SOS”) awareness, the SOS to “rescue” learners (all of us).1 “I try my best to be Zusha” could be an answer, still a work in progress.

wald-b
Hedy S. Wald, PhD is a Clinical Associate Professor of Family Medicine at the Warren Alpert Medical School of Brown University where she directs the reflective writing curriculum in the Family Medicine Clerkship and was honored with the Dean’s Excellence in Teaching Award.

REFERENCES

  1. Hedy S Wald, David Anthony, Thomas A Hutchinson, Stephen Liben, Mark Smilovitch, Anthony A Donato (2015). Professional Identity Formation for Humanistic, Resilient Physicians: Pedagogic Strategies for Bridging Theory to Practice. Academic Medicine 90(6): 753-60.
  2. Lee Shulman (2005). Signature pedagogies in the professions. Daedalus 134.3: 52-59.
  3. Lin Lin, Patricia Cranton (2005). From scholarship student to responsible scholar: a transformative process. Teaching in Higher Education 10(4): 447-459.
  4. Hedy S Wald (2015). Professional Identity (Trans)Formation: Reflection, Relationships, Resilience. Academic Medicine 90(6): 701-6.
  5. Hedy S Wald, Aviad Haramati, Yaacov Bachner, Jacob Urkin (2016). Promoting Resiliency for Interprofessional Faculty and Senior Medical Students: Outcomes of a Workshop Using Mind-Body Medicine and Interactive Reflective Writing. Medical Teacher in press.

 

8 thoughts on “Becoming Zusha: Reflecting on Potential in Medical Education and Practice

    • Thank you Bernadette for your kind words which validate this work in medical education and practice…and as you so elegantly express, in life! And thank you for the reblog! This is gratifying for a writer.

      Liked by 1 person

  1. I deeply appreciate this article, which supports the nurture of IRW as a vehicle for reflective practice, both as educator role-model and as practitioner. This particularly salient against the backdrop of rapidly changing medical knowledge and increasing pressures on practitioners. There is an area this article sidesteps: How should educators overcome the typical resistance to reflective writing, such as data from Coleman and Willis (2015, pp. 906-911) that indicates many student clinicians found reflective writing daunting, despite finding it of value to their learning?
    Research supports reflection as a critical component in learning. Reflection provides us with a means of developing knowledge and identifying “specific beliefs, feelings, attitudes, and value judgments that accompany and shape [that] interpretation” (Alcauskas & Charon, 2008, p. 892), while creating a vehicle for sharing our gleaned insights with others. Zeichner and Liston (2013) identify the impact reflection has on learning not only on the learners, but on educators, contending that using reflective teaching crosses the lines of various educational traditions and brings focus and higher teacher engagement to “the teaching self” (p. 78). Is there a means of encouraging both iterative and vertical dimensions of reflection (Mann et al., 2009, pp. 595-621) within an educational environment that continues to compress more information into smaller time frames, thus diminishing opportunities for reflective practice, which can then be dismissed as too time-consuming?
    —-
    Alcauskas, M., & Charon, R. (2008). Right brain: Reading, writing, and reflecting: Making a case for narrative medicine in neurology. Neurology, 70(11), 891-894. doi:10.1212/01.wnl.0000304945.48551.13.
    Coleman, D., & Willis, D. S. (2015). Reflective writing: The student nurse’s perspective on reflective writing and poetry writing. Nurse Education Today, 35(7), 906-911. doi:10.1016/j.nedt.2015.02.018.
    Mann, K., Gordon, J., & MacLeod, A. (2009). Reflection and reflective practice in health professions education: A systematic review. Advances in Health Sciences Education, 14(4), 595-621.
    Zeichner, K. M., & Liston, D. P. (2013). Reflective teaching: An introduction. New York, NY: Routledge.

    Liked by 2 people

    • Thank you for such a thoughtful reply Lani. The need for reflective, resilient, humanistic practitioners for competent and compassionate care is clear in regard to patient satisfaction and outcomes. Thus, the need for creating curriculum space for reflection and connection (which can help cultivate resilience, wellbeing and empathy) is increasingly recognized, including the need for faculty development on effective use of interactive reflective writing and small group facilitation. I am providing faculty development workshops internationally for such skill sets given broader interest in professionalizing medical education including for these topic areas. Positive impact on faculty’s lifelong professional identity formation and wellbeing can have a ripple effect for learners (and ideally for patients). Promoting a “reflective culture” within a positive learning environment and training of faculty for enhancing the educational value of feedback to students’ reflective writings can hopefully result in “buy-in” for curriculum directors, faculty, and trainees.

      Liked by 1 person

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