Jamaica Kincaid’s “Girl” and the Challenge of Growing Up in Medical Training

Abstract

ash the white clothes on Monday and put them on the stone heap; wash the color clothes on Tuesday and put them on the clothesline to dry; don't walk bare-head in the hot sun.These are the opening lines of "Girl," a story by author Jamaica Kincaid (The New Yorker, 1978). In it, Kincaid distills thousands of experiences from an Antiguan childhood into 49 instructions from mother to daughter. They are instructions for many tasks-for cooking, for survival, for household peace. They are delivered quickly, with precise detail, with smothering affection, without apology. They resonate, unsurprisingly, in our narrative medicine workshop with young physicians who are joining hospital teams, caring for patients, and learning a culture of medicine that asks them to rapidly adopt the knowledge, style, and practices of senior physicians they are working for. Kincaid offers the group a type of education not unlike their own training-a curriculum that can be unofficial yet forceful. With striking similarity to a young girl growing up in an adult world, new physicians join a system that demands they quickly learn the skills of their craft, the rules of survival, and the values they will fight for all while navigating their instinctive psychological responses to illness, injury, healing, injustice, and grief.The power of arts and literature to interpret a complicated world is well understood if still underleveraged in medical training. As a 3-person faculty group (a Pulitzer Prizewinning journalist as director, an emergency medicine physician as assistant director, and an internist as Associate Dean for Student Affairs and Medical Humanities) in a burgeoning narrative medicine department of a busy urban hospital and medical school, we pursue a mission outlined in The Principles and Practice of Narrative Medicine: "To develop deep and accurate attention to the accounts of self that are told and heard in the contexts of healthcare." 1 We began with a single workshop with surgical residents in 2017, using "Girl" after seeing it used at Columbia University that same year. Since the 2018-2019 academic year, we have conducted quarterly 1-hour narrative medicine workshops as part of the didactic curriculum of 7 residency programs, typically with residents of a single specialty at various levels of their training. The workshops are mandatory for residents; faculty occasionally attend. We also conduct elective coursework in the medical school, writing workshops for all employees of the health care system, and a voluntary lunchtime gathering that brings together students with interests in narrative medicine. In all, we constantly explore ways to help physicians, nurses, staff, and students "develop attention."After a brief introduction explaining who we are and our hope for the role of this work in graduate medical education,

Content and outcomes of narrative medicine programmes: a systematic review of the literature through 2019

“…During the second screening stage, we read the full texts of records, identifying a further 109 records to exclude due to our discovering on full-text review that they did not meet our established eligibility criteria (figure 1). Following the full-text screening, 61 records qualified for review 15 22 33–89. However, we discovered that several qualifying records addressed identical NM programming efforts at the same institution: that is, 12 records15 22 41 42 44–48 52 70 84 represented 6 programmes.…”

A narrative medicine intervention in pediatric residents led to sustained improvements in resident well-being

“…Other studies in residents and medical students have found similar themes, including creating a safe space [ 17 ], and increasing mindfulness [ 12 , 18 ], reflection [ 12 , 18 , 20 ], empathy, emotional processing and well-being [ 18 ], and a sense of community through building relationships [ 12 , 18 ]. These interventions have mostly been well-received and have shown to increase joy and meaning in work and ability to serve patients [ 12 , 15 , 20 ]. In one study, similar to our own results, many participants also commented that narrative medicine facilitated significant personal growth [ 12 ].…”

“…There have been a few published studies on the use of narrative medicine among residents and fellows, ranging from an essay contest for urologists [ 14 ] and a single session in a surgical residency [ 15 ] to longitudinal interventions for OBGYN residents [ 16 , 17 ], internal medicine residents [ 18 , 19 ], neurology residents [ 20 ], and pediatric critical care fellows [ 21 ]. These studies generally showed increased empathy and perspective taking [ 16 ] and decreased burnout [ 16 , 21 ], as well as improvements in general well-being [ 18 , 19 ] and mindfulness [ 18 ].…”

“…These studies generally showed increased empathy and perspective taking [ 16 ] and decreased burnout [ 16 , 21 ], as well as improvements in general well-being [ 18 , 19 ] and mindfulness [ 18 ]. These interventions also gave participants a sense of joy [ 15 ] and meaning in their work [ 14 ] and opportunity for self-reflection, listening, and discussion [ 20 ].…”