Title: FLAP: Personal Writing as a Tool for Physician Well-being Journal Issue: Journal for Learning through the Arts, 2(1) Author: Reilly, Jo Marie, White Memorial Medical Center Family Medicine Residency Program Ring, Jeffrey, White Memorial Medical Center Family Medicine Residency Program Publication Date: 2006 Permalink: http://escholarship.org/uc/item/63j3s91k Acknowledgements: Keywords: Humanities, Physician Wellbeing, Medical Education Local Identifier: class_lta_2534 Abstract: There are many physical and emotional demands that are required in the professional training and socialization of a physician. Writing for self-expression and awareness has been shown to improve personal growth and decrease stress levels. Using writing as a tool in residency training as a forum for exchange and self-expression can foster a healthier learning environment. FLAP, Family Practice Literature and Arts Periodical, is a community--family practice residency-based-- publication that allows residents and faculty to share their literary talents. It focuses on physician well-being and how writing can be used as a tool to manage stress. It is an English-Spanish bilingual publication that supports many forms of artistic expression and the diverse cultural and languages backgrounds represented by the residency community. It has received much positive feedback from residents and staff for its affirmation of physicians' professional development and attention to self care. Copyright Information: All rights reserved unless otherwise indicated. Contact the author or original publisher for any necessary permissions. eScholarship is not the copyright owner for deposited works. Learn more at http://www.escholarship.org/help_copyright.html#reuse eScholarship provides open access, scholarly publishing services to the University of California and delivers a dynamic research platform to scholars worldwide. RReeiillllyy aanndd RRiinngg:: FFLLAAPP:: PPeerrssoonnaall WWrriittiinngg aass aa TTooooll ffoorr PPhhyyssiicciiaann WWeellll--bbeeiinngg Introduction Studies have demonstrated that physicians’ experiences increase incidences of depression, substance abuse, suicide and distress compared to the general population (1). These types of stress begin early on in a physician’s training with the academic rigors of medical school. Teaching and role- modeling healthy coping skills are critical to training young physicians who are balanced and whole. Finding adaptive coping skills that prepare the student and resident for the physical and emotional rigors of medical education can better equip them for their professional journey. Doctors at all levels of their profession need healthy ways to express the tremendous physical and emotional challenges that they face daily. Writing as a means of self expression has been shown to improve personal growth and raise self-awareness (2). By writing their stories, doctors have an opportunity for self-reflection, a healthy stress outlet, and an opportunity to improve the “art” of patient care and to share their experiences with colleagues. Residency training is a significantly stressful period in a physician’s career path. Using writing as a forum for exchange, creativity and self-expression can foster a healthy learning environment. While there are a growing number of peer-reviewed medical journals where physicians can publish poetry, prose and stories, these are available to few physicians, limiting opportunities where physicians can share their creative works. This is particularly the case for students and residents in training who are less likely to find the support and mentoring to share their literary and artistic works with a broader audience. The evolution of FLAP It was from this climate that FLAP, the Family Practice Literature and Arts Periodical,was born several years ago. It was created (1) as a venue for residents, 11 JournJaolu fronra Ll efoarr nLienagr nthinrogu tghhro tuhgeh A trhtes, A2r(t1s),, 2A(1rt)ic (l2e0 60 6(2)006) faculty and support staff to share their literary and artistic talents; and (2) to focus on physician well-being and how writing can be used as a tool to manage stress. Inspired by athen second year resident and published quarterly, FLAP solicits contributions from the entire residency staff, including the residents themselves, faculty, nursing staff, physician assistants, psychologists and social workers. FLAP submissions are electronic and include short stories, poetry, prose, essays, memoirs and reflections. We ask FLAP contributors to honor their responsibility to patient confidentiality. References to patients are masked to protect identities without losing the flavor of the doctor-patient interaction the author aims to describe. The periodical is edited by a resident who champions the project. It is supervised by our psychologist with physician feedback and support. The family practice residency secretarial staff is responsible for the periodical’s production. It is distributed internally to the White Memorial Family Medicine Residency Program (WMFMRP) and shared with the local hospital campus. Production and distribution costs are kept low, because the publication is done internally; it is in black and white, uses regular paper and is not bound. To the authors’ knowledge, FLAP is one of the few forums where residents can express and share their artistic work during residency training. FLAP has received favorable reviews from the faculty, residents and hospital community. It has also been lauded by medical students at health fairs and during the residency interview season. It has been positively commented on at faculty meetings, residency house-staff meetings, and at “H and H” (healing and hopefulness), a monthly forum that addresses the positive role of the physicians and staff as healers (3). The graduating third year resident who began the project noted in his “last issue”; “For me, it 22 RReeiillllyy aanndd RRiinngg:: FFLLAAPP:: PPeerrssoonnaall WWrriittiinngg aass aa TTooooll ffoorr PPhhyyssiicciiaann WWeellll--bbeeiinngg has served as a venue to learn that even in the worst moments of our lives, we are not alone.” Its contents have been diverse, from interviews with staff on the “art in their practice of medicine,” to poetry, short stories and reflections on personal loss of loved ones. FLAP has included stories of what residents and staff do to maintain balance during the stress of life and residency. Contributions range from a personal reflection on “why I run” to a chief resident’s piece on the beginning mosaic tile class she took as a way of relieving the everyday pressures of residency. She wrote: “Each night I looked forward to the morning where I would de-stress by breaking tile pieces to look for the perfect fit to the puzzle I was creating on my table. After I finished my table, I placed it in my living room as a reminder of my journey through my second year of residency.” She ended by stating, “I am in no way a tile expert. I am just a second year resident that has a mosaic way to relieve the every day pressures of residency.” FLAP is also unique in that it is a bilingual English-Spanish publication. Our residency community is located in the inner city of East Los Angeles. Many of our residents and support staff have come from the surrounding community or similar communities. As such, Spanish is the native language of some of the residents and staff and part of their culture or the culture of the community they serve. As FLAP is a publication that allows for the free expression of creativity in the arts, our publication supports the cultures and languages represented by the residency community. We began FLAP to answer three questions in our family practice residency community: 33 JournJaolu fronra Ll efoarr nLienagr nthinrogu tghhro tuhgeh A trhtes, A2r(t1s),, 2A(1rt)ic (l2e0 60 6(2)006) 1. Does writing by physicians provide a means of reflection on patient care and provide a stress reduction forum? 2. Does the reading of these stories by our colleagues provide insight, meaning and mutual understanding of the challenges and joys of patient care? 3. Can FLAP be a forum where residents will publish their writings and express their artistic talent? Our experience has affirmed the importance and value of writing as a tool in medical education, physicians’ professional development, and physicians’ attention to self-care. As noted by one of our graduates in his senior project on FLAP, it has been a testament “to humans need to share their experiences, vulnerabilities and the uncertainties of medical training, ….to regularly express their needs to reflect and grow in a safe environment…and to identify the substantial need for more aggressive outreach to physicians with the stresses of their medical life.” References 1. Quill T, Williamson P. Healthy approaches to physician stress. Arch Intern Med 1990; 150:1857-1861. 2. Shapiro J, Lie D. Using literature to help physician-learners understand and manage difficult patients. Academic Medicine 2000; 75(7):765-8. 3. Reilly J, Ring, J. Healing and hopefulness: A tool for physician well-being. Medical Education 2005: 39(11): 1158-1159. 44