By Hedy Wald

Looking back, looking forward. It’s what we do on the eve of a new year. 24 hours away from a fresh start, resolutions, inspirations, and even some trepidations . . .  2020 sounds like science fiction and yet, here we are.

Social media is gushing with good wishes and plenty of party hat and heart emojis. @pranaysinha summed it up nicely: “Hope, love, and gratitude.” And following the Dalai Lama on Twitter can make your day; @dalailama: “I believe that if we make an effort to develop peace of mind within ourselves and cultivate a proper appreciation of the oneness of humanity, we can create a happier, more peaceful world. What we need is common sense-the positive use of intelligence-and warm-heartedness.”

So it’s not all party gaiety, it’s also serious contemplation of where we’ve been, where we are, and where we’re going. Resonates for me with the Ten Days of Repentance associated with the Jewish new year . . . reflect, look inward before looking outward – apologize, improve, be kind.

So many parallels to our vision for humanism in medicine. And for the work we do in medical education.  It’s about doing the work of a physician but it’s also about being a physician¹ –how do we cultivate a prepared heart and mind for the inevitable complexities? Ethical vigilance? Values? Moral integrity and resilience? And when we close that exam door and are face-to-face, heart-to-heart with that vulnerable, suffering human being and/or family caregiver, how do we bring intentional presence² to that sacred space with readiness to receive and hear the narrative, readiness for responsibility?

Reflective practice can help; making the active, dynamic, and constructive process of professional identity formation (PIF) explicit in the curriculum with appropriate faculty development can help.³ PIF is relational, not “delivered” and interactive reflective writing (IRW) can be effective for grappling with the lived reality of medicine as well as societal challenges.³

There’s more. How are we treating each other in the learning, clinical practice, and research environments? Can we bring the values we espouse for humanistic patient care into the workplace with colleagues and educational climate with trainees? Relationship-centered care? So relationship-centered education.⁴ Person-centered care? So student-centered education. Mindful practice with patients? So mindful teaching of trainees and mindful interactions with interprofessional teams. Kindness as a lifestyle with sensitivity to personal and professional narratives of those around us.

I published about this in the context of a very challenging year and a very challenging loss. Yes the personal and professional collide. Over 100 readers wrote to me (and many more on social media) about my essay “Helping my Husband Live and Die”⁵ which emerged like a spiritual experience one week before that beloved human being passed. “Kindness matters,” I wrote, as the unimaginable was unfolding in my life. “So does opening your head and heart to narrative. For patients and similarly, for colleagues around us who may be coping with significant stressors personally if not professionally. ‘Narrative medicine’ includes both personal and professional stories— do we have the courage to hear them with intent to help?” Standing on stage in Basel for an AMEE (Association for Medical Education in Europe) plenary while speaking on “Integrative Resilience,” I invited a full conference hall of health professions educators to consider that the words ‘How can I help?’ may be the culture change we’re looking for. Yes, the personal and professional collide. In addition to your patients, what may your colleagues and trainees be grappling with? How can you, I, we help?

I’ve been reflecting on gifts of connection in my life that help ease the pain. Family, friends, sweet people on line at the grocery store who make me laugh. About joys in teaching when students let you know you’ve made a difference. About the snail mail thank you card from occupational therapy students at the Mayo Clinic that now sits on my desk for inspiration. About unexpected gifts of time that can be transformative. I am, for example, filled with gratitude for the privilege this past year and now in the new year of working with students and faculty at the Witten-Herdecke Faculty of Health, Germany to use the history of medicine, the Holocaust and medicine, for reflecting on the becoming of a health professional and more broadly, being a human being.⁶  This endeavor has been an opportunity to realize the integration and application of my scholarship on IRW, PIF and this history as I facilitate reflection within their “Cultivating Medical Awareness and Ethics Through the Example of Medicine During National Socialism” course and reciprocally, experience growth of my own lifelong PIF. I now braid personal and professional narratives when discussing this topic with students and faculties across the U.S.  So relevant to contemporary medical dilemmas and societal issues of preserving human dignity.

One more reflection-inviting question. How might we shine the light on triumphs and successes in our work and in our life, when, in the words of Barbara Fredrickson, we are faced with “the positive whispers and the negative screams?” We can do this. It is, after all, the eve of a new year.

Hedy S. Wald, PhD is Clinical Professor of Family Medicine at the Warren Alpert Medical School of Brown University and Faculty, Harvard Medical School Global Pediatrics Leadership Program. She presents internationally on interactive reflective writing-enhanced reflection supporting professional identity formation, promoting resilience and wellbeing, and Holocaust and medicine in health professions education and practice.

REFERENCES

1. Sandra Jarvis-Selinger S, Daniel D Pratt, Glenn Regehr. (2012). Competency is not enough: integrating identity formation into the medical education discourse. Academic Medicine 87(9): 1185-90.
2. Hedy S Wald, Aviad Haramati. (2015). Hineni – I am Here: On Presence and Sacred Space. (Special section – Spirituality in Medicine – Creating Sacred Space.) Journal of Alternative and Complementary Medicine 21(6): 247-250.
3. Hedy S Wald. (2015). Professional Identity (Trans)Formation in Health Professions Education: Reflection, Relationship, Resilience. Academic Medicine 90(6): 701-706.
4. Michael W Rabow, Maya Newman, Rachel N Remen. (2014). Teaching in relationship: the impact on faculty of teaching “the Healer’s Art.” Teaching and Learning in Medicine 26(2): 121-8.
5. Hedy S Wald. (2019). Helping My Husband Live and Die. Journal of the American Medical Association – Neurology 76(4):396-397.
6. Shmuel P Reis, Paul Weindling, Hedy S Wald. (2019). The Holocaust, Medicine, and Becoming a Physician: The Crucial Role of Education. Israel Journal of Health Policy Research 8:55.