Background: Medical students can experience declines in empathy during training, especially in their third year.1,2,3 These declines correlate with several factors that contribute to burnout.3 At the Medical University of South Carolina, expressive writing modules were created to help clinicians address burnout. Yet these modules were not made available to health science students, who may benefit from expressive writing as part of self-care. This quality improvement project utilized a 6-week program informed by the Pennebaker Method4 to assess the impact of these writing modules on resilience, self-compassion, and self-efficacy in third-year medical students.
 Materials/Methods: Students from the third-year College of Medicine class self-identified their willingness to participate in this 6-week assessment project. The Connor Davidson Resiliency Scale Short Form 10 and the Generalized Self-Efficacy Scale were administered pre and post intervention to investigate changes in resilience and self-efficacy. After submitting pre-intervention surveys, students completed weekly expressive writing modules for 5 weeks and answered open-ended responses about each writing experience. These open-ended responses underwent 1) qualitative analysis and 2) quantitative content analysis using text-mining software, KhCoder.

Results: The Connor-Davidson Short-Form 10 showed a significant improvement in resilience 
(p = 0.015) between pre and post intervention. The Generalized Self-Efficacy Scale showed significant reduction in anxiety (p = 0.04589). Qualitative analysis revealed that students found value in writing from others’ perspectives, reflecting on gratitude, reconnecting to purpose, and reaffirming professional identity. KHCoder data supported these findings.

Conclusion: These expressive writing modules may help students gain new perspectives on professional identity, past challenges, past successes, and future growth at a pivotal time in their training. Doing so can support resilience, self-compassion, and self-efficacy. Two limitations of the project were the small sample size (N=14) that reduced its power. An assessment with a larger sample of students, including a control group, would provide more robust data on the value of these modules.

References:

1. Andersen, F.A., et al. Revisiting the trajectory of medical students' empathy, and impact of gender, specialty preferences and nationality: a systematic review. BMC Med Educ. 2020; Feb 17; 20(1):52. doi: 10.1186/s12909-020-1964-5. 

2. Hojat, et al. Does empathy decline in the clinical phase of medical education? A nationwide, multi-institutional, cross-sectional study of students at DO-granting medical schools. Acad Med. 2020; 95: 911-918. 

3. Neumann, et al. Empathy decline and its reasons: A systematic review of studies with medical students and residents. Acad Med. 2011; 86 (8): 996-1009.

4. Pennebaker, J.W. & Smyth, J. Opening up by writing it down: the healing power of expressive writing (third edition). New York: Guilford. 2016.

The Write Track: Can Digital Expressive Writing Modules Promote Resilience, Self-Compassion, and Self-Efficacy in Medical Students?

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