by Delese Wear, PhD and Joseph Zarconi, MD
In a recent Academic Medicine article entitled “Slow Medical Education“*, we described the guiding ideas of the slow movement—a cultural shift that aims at slowing down the pace of life and places value on deliberate, thoughtful, connective behaviors and attitudes. Slowness, of course, is not relevant or even desirable everywhere in medicine but the slow movement does have significant relevance to medical education.
One of the tenets of the slow movement is learning to do things at the right speed. Indeed, some skills can be mastered rather quickly; some learning is best assessed with rubrics; some situations require decisiveness. But this is not the case for all that we do in medical education.
Our faculty is particularly interested in applying the slow movement to helping medical students develop their individual physician identities with greater consciousness and self-reflection. This goal calls for something different: something untethered to our lust for assessment, for orderly curricular sequencing, for speed and efficiency, and for things to be neatly standardized.
But we are struck with how much time—and that means dedicated time—must be afforded to students in order for them to undertake the quality of reflectiveness required for personal identity formation. Students must be given this dedicated time before we can ask them to work in narrative-based domains that eschew hurriedness. As clinical and humanities faculty who teach throughout the four-year curriculum, we look for such dedicated time, and because it is a priority of our college of medicine, we often manage to find it.
The course we direct, “Reflective Practice,” is narrative-based: one finds a Raymond Carver story next to a Christopher Hitchens’ essay next to a newspaper story next to a poem next to a movie from Netflix. Students’ personal engagement with such narratives takes time; discussing them in the classroom community takes time; faculty’s written responses to their essays (often a back-and forth with students) take time. Like relationships found in larger slow movements (such as the slow food or slow travel movements), we get to know our students well. In doing so, we trade opportunities for speed and efficiency for relationships that evolve in written responses to students and discussions that last beyond classes.
Within the clinical environment, there are other opportunities to slow down. Abraham Verghese has written eloquently about the virtues of refocusing on the rapidly-disappearing (and time-consuming) clinical exam—not just for the useful clinical information provided, but also for the ritual of human touch, with all its power, and its poignancy.
We recently came upon a superb forum for advancing slowness in clinical settings. Drs. Pieter Cohen and Michael Hochman’s “Updates in Slow Medicine” began as a series of electronic discussions about developments in clinical medicine, among students, residents, and faculty at the Cambridge Health Alliance and Harvard Medical School. These discussions, which emphasize slow and thoughtful clinical reasoning, evidence based practice, and the importance of lifestyle changes for improving health, quickly found a national following and an appetite among health care professionals for slowing down. Their work strengthens our convictions about the need to carve out curricular time to expose medical students to the value of slower approaches. These approaches can help healthcare professionals to improve medical care for those they serve, and to make medical work more enriching and satisfying for those serving.
The authors also wish to acknowledge Arno Kumagai and Kathy Cole Kelly, who co-authored the article “Slow Medical Education” in Academic Medicine.
Delese Wear (Ph.D, Kent State University, 1981) is professor of Family and Community Medicine. Her research interests include the medical humanities, professionalism, and curricular issues in academic medicine. She is the co-editor of the Health and Humanities Reader (Rutgers) along with Therese Jones and Les Friedman, and Professionalism in Medicine: Critical Perspectives (Springer).
Joseph Zarconi, M.D., is senior vice president for medical education and chief academic officer and directs Summa’s Institute for Professionalism Inquiry which he co-founded. He is professor of internal medicine and associate dean for clinical education for Northeast Ohio Medical University (NEOMED). He has presented at state and national meetings and co-authored peer-reviewed journal articles and book chapters on topics relating to medical education, narrative medical practice, narrative ethics and humanism and professionalism in medicine. He is co-author of two books on narrative in healthcare.