As modern medicine and medical education have become increasingly industrialized, constraints imposed by duty hour limits, quality metrics, the electronic health record, and protocol-driven care plans continue to encroach on the sacred space between physician and patient. Often, the humanity we share with the patients we serve is obscured by the tedium of process, and we feel the effects of detachment. Too often, our identities and experiences as physicians do not conform easily to check boxes or to set shifts, and we need to be reminded that it is acceptable to spill over the lines. Through storytelling and group reflection, physicians can gain perspective on the less measurable aspects of the profession, and reaffirm what a privilege it is to serve.

Since 2012, faculty members in the University of Pittsburgh internal medicine residency program have invited residents into their own living rooms for 3 to 4 evenings each year. During these sessions, termed Rounds for Reflection (R4R), we pour drinks, sit down, and share stories about patients and ourselves. Some stories are uplifting, some are frustrating, and some are heartbreaking. More than just the content, it is the process of sharing and of active listening that we find most cathartic and affirming.

Because the “hidden curriculum” of graduate medical training that leads to dehumanization and physician burnout is both structural and cultural, our intervention is designed to respond in kind. Whereas the clinical learning environment promotes a physical separation between physicians and patients, a hierarchical power dynamic, and strict time limits, R4R takes place in a shared and deeply personal space. It is entirely extracurricular, off-campus, and off-the-clock. Whereas the culture of the hospital arises from the use of medical jargon, an obsession with objectivity and the pretense of certainty, R4R promotes a more humane dialogue that values subjectivity and leaves room for ambivalence, nuance, and mystery.

The novelty of R4R lies not in the concept itself, for generations of physicians have derived comfort and inspiration from discussing their shared experiences. But as the landscape of graduate medical education becomes increasingly crowded and compartmentalized, a forum that seeks to address broader questions related to our humanity, identity, and purpose can seem both radical and refreshing. Indeed, persuading residents to devote time and attention to the human side of medicine has never been more challenging—or more necessary.

R4R costs virtually nothing but a willingness to engage with residents and peers on a more personal level than is customary within the confines of the hospital. Invitations are managed through a free Evite account, and a brief synopsis of each discussion is posted on 1 of the faculty member's websites (www.wardstories.org/r4r).

To date, 65 residents (roughly 20% of those invited) and 14 faculty members have attended at least 1 gathering, and many have become regular attendees. R4R welcomes guests with new perspectives and residents from other specialties, such as pediatrics and neurology, medical students, and 1 of our faculty member's fathers, who is a retired physician, have all attended. General themes from narrative feedback on annual, year-end surveys include an appreciation for a forum where it is safe to express uncertainty and vulnerability, and a sense that the exercise is both protective against physician burnout and inspiring for trainees. Selected narrative comments from residents are included in the table.

table

Resident Comments About Rounds for Reflection

Resident Comments About Rounds for Reflection
Resident Comments About Rounds for Reflection

Abbreviations: MICU, medical intensive care unit; R4R, Rounds for Reflection.

The impact of R4R extends beyond the participants. Since its inception 3 years ago, R4R has featured prominently in our recruitment presentations, and many candidates highlight this as a unique strength of our residency. That such a program exists sends an important message about the culture at our institution and the humanistic values we hope to cultivate in our trainees.