P3B058: Reflective Writing: A Pilot Program for Learners Rotating with a Pediatric Palliative Care Team

Background: Narrative medicine has been linked to improved communication skills, increased resilience, and decreased burnout amongst learners in the medical field and experts alike. Physician trainees can benefit from the opportunity to practice this skill in the hopes that it will be utilized throughout their careers; however, finding time to do so may be challenging when balancing clinical responsibilities.

Methods: Learners electing to rotate with our pediatric palliative care (PPC) team between March and July 2022 were invited to participate in a reflective writing pilot program. Six prompts were shared, with a final option allowing for an unguided reflection. Participants were asked to choose a prompt, reflect, and write. There were no requirements for length or formatting. Submissions were collected online with a brief survey about their reflective writing experience. They were offered the option to share their reflection with the PPC team anonymously, in person, or identified by name and read on their behalf.

Results: Eight of 12 learners (67%) participated in the program. Participants reported various levels of training: medical school, residency, and fellowship. Most (6/8, 75%) spent at least 2 weeks with the PPC team. Seventy-five percent of participants (6/8) agreed or strongly agreed that the reflective writing exercise enhanced their experience caring for children living with serious illness and their families (Figure 1). Seventy-five percent of participants (6/8) also disagreed or strongly disagreed that the reflective writing exercise created additional stress during their rotation (Figure 1). Most requested that their reflections be identified and shared with the team on their behalf (5/8, 63%), while two (2/8, 25%) preferred to share in-person and one learner (1/8, 13%) asked to remain anonymous. In a free-text response portion of the survey, one learner described the experience as “enriching.” Another shared the experience may have added “perhaps a little stress but not in a bad way” because they wanted to give the reflection “the proper time it deserved.”

Conclusion: Our learners’ responses to the pilot program were overall positive. They found the experience to be beneficial without being overburdensome. Offering choices to share their reflections empowered learners to choose their vulnerability comfort level. We hoped that this emphasized protected sharing in our team environment and encouraged transparency in their reflections. Given the known benefits of narrative medicine and the importance of building sustainable wellness practices, PPC programs should consider offering rotating learners the opportunity to reflect and write as part of their PPC rotation.