Faculty of Medicine & Department of English Moral Imagination: The use of stories to create circles of empathy & understanding Lara Nixon MD CCFP, Tom Rosenal MD FRCPC, Laurie Pereles MD CCFP, Roberta Jackson PhD Background Results Empathy and the ability to shift perspective are crucial in healthcare1. Ambiguity and uncertainty are inherent to clinical practice. Visual arts interpretation exercises have been used successfully to improve participants’ comfort with ambiguity2. Unstructured, learner-driven discussion promotes deeper reflection3,4. Purpose • To encourage sensitivity to patients’ lived experiences and promote selfreflection, we developed a writing exercise invoking moral imagination that was used with medical students, residents, and practicing physicians. • “Moral imagination”: the ability to translate moral principles, known in other situations, to new challenges - a [cognitive] bridge that overcomes the gap between moral theories or common-sense morality, and practical decision-making or everyday behaviour5. • To create a safe space where participants would express their own thoughts and feelings indirectly. Moral Imagination…a bridge Daily Actions & Practical Decision-making Moral Theory & Common-sense Morality Stanin Photography. Accessed Apr9/13 www.flikr.com Creative Commons Methodology • participants were asked to choose a picture and reflect on that person’s lived experience and to write about this in any format they chose. • Ten minutes was given to construct the story and then each participant read their story to their group. (1.) Buckman R, Tulsky J, Rodin G, (2011) Empathic responses in clinical practice: Intuition or tuition? CMAJ, 183(5), 569-71. (2.) Schaff P, Isken S, Tager R, (2011) From contemporary art to core clinical skills: observation, interpretation, and meaning-making in a complex environment. Acad Med, 86(10), 1272-1276. (3.) Boud D, Walker D, (1998) Promoting reflection in professional courses: the challenge of context. Stud Higher Ed, 23(2), 191-206. (4.) Weisberg M, Duffin J, (1995) Evoking the moral imagination: using stories to teach ethics and professionalism to nursing, medical, and law students. Change, 27(1), 20-27. (5.) Werhane P, (1998) Moral imagination and the search for ethical decision-making in management. Bus Ethics Quart, 8(1), 75-98. I wish I could find my teeth-It should be easy. The young ladies who run this place seem to know where everything is-I mean, they know when it’s time to eat, when I should sleep, when I need to wash. I don’t have to think about anything. Maybe that’s why I can’t find my things. I was married once. I think. I say that because sometimes a nice woman comes by and tells me she’s my grand-daughter. That means I must have had some children. And since you can’t have children out of wedlock, well…when she comes, I can’t seem to find the proper words to tell her how grateful I am for her presence. So I give her my best smile. The one into which I put all my love, and all my happiness, and try to tell her with my eyes that I’ll miss her when she goes away. But you can’t smile like that without any teeth. I wonder if she’ll show up today The first day of school. A new country, a new language A new school, a new class. No one I know Probably no one who understands, no one who cares. I’m scared. What if they don’t like me. My clothes are not right, I don’t look like them. I think I’m bigger than everyone else. And I’m fatter. I don’t know how to act. I don’t fit in. They don’t know what war is like. I can shoot a gun. My dad is dead. My mom has to work [and] my little sister is sick. They’re counting on me. It’s time to…go…in… I am comfortable being alone, it is easier than the messy complexity of life with people who love you, people who want to change you, people who think you are more than you are, people who wish you were more than you are. Love has too many expectations Loneliness is comfortable. Predictable. I just want to get by. Participant authors & Creativity • Participants’ stories demonstrated creative thought, curiosity about, and empathy towards those in the pictures. Collaborative Meaning-making • Evoking different perspectives (and moral imagination) in a creative, collaborative safe space facilitated learning about each other (and hopefully, about ourselves), especially when multiple group members wrote about the same photograph. • Unstructured discussion and sharing of their writing appeared to promote deeper reflection than might have been expected with a question-answer, facilitator-led session. Ambiguity • Some participants expressed discomfort with speculating on the lived experience of the person in the photograph. There seemed to be some fear of “getting it wrong”. When multiple group members wrote about the same photograph, ambiguity became explicit and provided opportunity to navigate ambiguity together. Conclusion Participants used creativity and collaborative meaning-making to explore alternate perspectives and ambiguity. Limitations: Some participants wrote only brief notes, narrating a much fuller story that was not captured in writing. More reflective stories might have appeared if more time was given. Selection bias due to voluntary nature of the session and submission of the writing may limit generalizability to larger groups or mandatory curriculum. Ideas for future: Embed this exercise in a range of exercises that are designed to gradually introduce ambiguity to increase participants’ tolerance for indeterminacy.