Purpose

Critical reflection helps to animate humanistic values needed for professional behavior in medical students. We wanted to learn whether poems written by physicians could foster such critical reflection. To do so, we determined whether the poems elicited dissonance (i.e., recognition of their own or others behavior as incongruent with their values) and subsequent reflection or critical reflection by teams of students in a medical biochemistry course.

Subjects and Methods

Thirty learning teams of five to seven members each (total of 196 first-year osteopathic medical students) related four humanistic values or characteristics of professional behavior to an associated poem written by a physician. Their written individual and team reports were assessed for dissonance, reflection and critical reflection. We also determined whether dissonance (if it occurred) was resolved through preservation of students’ values and behavior (and rejection of other’s behavior) or through reconciliation of their own incongruent humanistic values and professional behavior.

Results

All 30 teams exhibited dissonance and reflection in their written reports, and 18 teams showed critical reflection. Fifteen of the latter 18 teams displayed reconciliation after critical reflection, and five of those 15 teams also showed preservation. The other 15 teams exhibited preservation, but not reconciliation, after either critical reflection (three teams) or reflection (12 teams). At least two teams exhibited related but deeper critical reflection in more open-ended written work outside the formal assignment of this exercise.

Conclusions

The poems we used were virtually certain to evoke dissonance in learning teams. Behavior exhibited by patients or health care personnel in some of the poems contradicts most people’s values for proper behavior. Placing focus on imperfect behavior by others can, however, limit recognition of one’s own hypocritical actions. To obviate such limitations of more structured assignments, we encourage provision of tacit opportunities for critical reflection outside structured formal assignments. The exercise we used led at least two teams of students to exhibit deeper critical reflection, outside the formal assignment, in order to reconcile their incongruent values and professional behavior. Moreover, the exercise itself led most teams to exhibit critical reflection needed to animate humanistic values and professional behavior in medical students.