Dr. Allan D. Peterkin, from the University of Toronto, uses written narratives to teach professionalism. Dr. Peterkin relates that all residents witness or experience clinical and academic encounters during which something "unprofessional" or even unethical happens. Many are reluctant to report or discuss such incidents, and thus their experiences remain unprocessed and may color attitudes about work, colleagues, and patients. This approach allows for shared reflection and problem-solving. Dr. Peterkin engages trainees in lively discussions about what medical professionalism "in the real world" means and to reflect on apparent breaches by having them write about specific situations.
He uses a one-time writing prompt with both family-medicine and psychiatric residents in one of their scheduled core seminars. Dr. Peterkin asks residents to: "write about an experience that felt unprofessional" and gives them 5–20 minutes to write a draft onsite. He suggests that they choose a specific incident and write a personal story, in the first person, with a beginning, middle, and end, in a way that conveys not only what happened, but how they felt about it emotionally. This instruction, informed by narrative theory, is more structured than usual assignments for "critical incident reports" (6, 7). He instructs residents to "write the way you would speak if telling this to a friend or trusted colleague" and not to worry about spelling, grammar, or syntax. He asks one or two volunteers to read their pieces aloud and to then remain silent as their peers comment, share feelings, or ask questions. This allows readers to hear and appreciate differing and sometimes surprising views and interpretations in response to what they have shared. Dr. Peterkin sets group-feedback parameters, which include not interrupting the reader, emphasizing strengths of the piece, and providing helpful edits in a respectful manner. When he invites the readers back into the discussions, they have the right to say as little or as much about the stories as they want, remaining in full control of what is elaborated. The importance of maintaining confidentiality around these written incidents is emphasized, because some of these experiences will not have yet been shared elsewhere.
At the end of the session, Dr. Peterkin asks those who did not read to summarize their stories in a few lines.