Clinical

3 Tips for Incorporating Writing Into Your Medical Training

Rachel Bigley and Dr. David R. Pepper
Published on Jul 1, 2020. Updated on Sep 15, 2020.

Reflecting on your clinical experiences through writing is an important exercise for clinicians. Not only is it useful for processing information and learning from each clinical encounter, it’s also a highly cathartic experience that helps clinicians build empathy with the people in their care. For today's entry on the Osmosis blog, Osmosis Medical Education Fellow Rachel Bigley co-authored a piece with her preceptor, Dr. David R. Pepper, explaining how you can incorporate writing into your medical training.

Osmosis illustration of a medical student writing about her clinical experiences.

The medical student perspective

From day one of my longitudinal family medicine preceptorship, I began writing after every clinical experience with my preceptor, Dr. Pepper, titling the entries: “Patient Encounter Diary.” In each entry, I would write about the patients I saw that day, patterns I observed, the flow of the clinic, my interactions with my preceptor, or how patients’ stories had moved me. By doing this weekly, the writing began to flow more easily and I realized how much I was processing: this exercise was helping me build a strong foundation of medical knowledge and also revealing what type of doctor I wanted to be. I began appreciating the process of reflection and also my ability to document the evolution of my clinical experiences. 

Looking back at the entries now, I can better understand how I arrived at my interest in OB/GYN and how I noticed subtle differences between patients’ experiences that I would have otherwise forgotten. As I continued to write, I was honing my ability to jump into the writing process whenever I felt lost, when I was trying to understand a patient interaction, or recognize the systemic barriers to care that many patients unfortunately endure. 

Writing in medicine can provide a deeper connection to the humanity of patients and yourself, and provide a welcome pause in the fast-paced day-to-day of medicine. The joys and the frustrations, the conflicts in the mentor-mentee relationship, and the devastations many patients experience in their lives all have come out in my writing. By sharing my views and what I learned with my preceptor, our relationship strengthened. This allowed me to feel more a part of the clinical team and strengthened my bond with Dr. Pepper, allowing me to play a larger role in patient care. 

If you decide to start writing during your medical training, know that each iteration of entries will show you what works for you, as well as what doesn’t. Don’t be too hard on yourself. The stories and thoughts will come—this is medicine. We are all here for life-long learning, and we all have the incredible privilege to learn about many people’s lives and stories. Embrace it.

Osmosis illustration of a quote explaining the importance of writing about clerkships.

The preceptor perspective

Rachel began writing from week 1. She asked if she could share the pieces, and our email conversations began. I would read the stories, cases, and issues she raised each week with interest. We would often talk about them the following week, either in-person or over email. She commented on the care patients living with disability received; how the children we saw teased and played with us. She described her first PAP. She saw and described the human interactions, my behaviors, and the nature of family medicine in a way that took me outside it—and allowed me to see things differently—and learn more. She both made our patients more whole, and our interactions more meaningful.

Writing gave Rachel agency and a voice from which she was able to contribute in major ways to both of our learning. She also raised relevant questions on a weekly basis—from the simple preventive questions to complex death and dying ones. In addition to getting to know my patients better, I was learning about myself and Rachel. Her exercise eventually blossomed into us forming a writing group (after her 18 months as my mentee). Our partners joined in, and we have all been enriched by written explorations into clinical settings and human stories.  We have even dabbled in poetry. It has been the gift that keeps on giving.

Osmosis illustration of a medical student and her preceptor discussing narrative medicine.

Dr. Pepper’s 3 tips on how to incorporate writing into your medical training

1. Include your preceptor from the beginning

From day one, ask your preceptor if they’d be interested in reading a reflection you’ve written about your day at the clinic. You’ll have to make sure your relationship with your preceptor is inclusive of this additional learning experience. They will most likely appreciate hearing about what you learned that day.

2. Share your writing with your preceptor and ask for feedback/responses

If you’re able to teach your preceptor something, then it’s a win-win. You get to write, you get to learn something, and then teach your preceptor something as well—perhaps about one of their patients, a disease, or the interactions you observe. 

3. Set a goal for yourself every time

It may be to write an opinion piece for KevinMD, or to write the entry in an hour, but it’s important to keep yourself moving forward.

Outline for a clinical encounter entry: (~1 hour total)

To help you get started incorporating writing into your medical training, I've created this brief outline for inspiration.

1. Reflection from the day (~1 page)

2. The “3-3s”

i) Three things you learned that day

ii) Three things you are going to look up

iii) Three things you are grateful for from the day

3. One goal for your next clinic or for writing

I hope these tips have encouraged you to pick up a pen and start writing about your clinical experiences. For many students, COVID-19 has impacted the clerkships aspect of your education tremendously, and you may have limited access to real-life clinical experiences. It’s never been more important to make the most of your clinical experiences, and writing about them is one way to make that happen. Best of luck!

About Rachel

Rachel Bigley is a 3rd year medical student at the UC Berkeley-UCSF Joint Medical Program (JMP). She is originally from Eugene, OR. She is hoping to go into OB/GYN, general surgery, or psychiatry—the decision will hopefully come during the course of her clerkships. In her free time, she enjoys running, hiking, camping, traveling, listening to live music, and spending time with her partner. 

About Dr. Pepper

David R. Pepper, MD is a volunteer professor at the JMP. He worked for 15 years in the hospital and has delivered over a thousand babies. He worked 6,000 hours in the ED. Now he focuses on death, dying, and living, while seeing patients and teaching in the outpatient clinics at Contra Costa County’s Family Medicine Residency. He shares many of Rachel’s free time hobbies, but bikes instead of running. He has an amazing wife and four children he’s passionate about.



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