INTRODUCTION
Within the medical humanities, narrative medicine and other creative writing programs may benefit practitioners by promoting physician wellness and reducing burnout.1–4 However, busy practitioners may not have the skills needed to fully utilize creative writing as a personal outlet and share their creative work through publication. Developing and sustaining a robust creative writing community for healthcare providers can be challenging due to interdisciplinary barriers, lack of funding, and limited institutional support. Masters-level programs as varied as Narrative Medicine at Columbia University or the Iowa Writers’ Workshop rigorously train medical professionals in creative writing, but require large time and financial commitments.5,6 Other reflective writing support groups within academic and hospital settings are common, but mainly offer time-limited programs or specialize in focused areas of creative writing.
To bridge these gaps, in 2007, we developed an innovative creative writing ecosystem for physicians and medical learners (students, residents, fellows, alumni), affiliated with Stanford University School of Medicine’s medical humanities program. Our program allowed access to the medical humanities and support for creative writing endeavors to promote well-being, professional development, and community building, as well as creative writing publications within a medical academic institution. For the past 15 years, The Pegasus Physician Writers Program at Stanford (Pegasus) has sustained a community of writers and sought to cultivate physician writers to contribute to the public discourse around humanism in medicine through publications such as opinion editorials, mainstream publications, and creative writing publications. Over time, the program expanded to include regular writers’ groups, craft and publication workshops, symposia, bookstore readings, special events, and a publication press. This qualitative survey on outcomes was conducted to elucidate the program’s impact on participants of a physician creative writing ecosystem within an academic institution.
METHODS
Between June and August of 2022, we surveyed 383 current and prior Pegasus members (post-training physicians and medical learners) about their experience with the program using an emailed Qualtrics XM (Provo, UT) anonymous survey. Development of the survey tool was based on previous qualitative program evaluation surveys and internally trialed. We included questions regarding demographics, creative output, creative expression, creative communication, creative publication, and creative wellness. Participants shared open-ended comments about Pegasus’s impact on personal growth, wellness, and publication. Outcomes were examined by training level at time of participation, as either medical learner (medical student, resident, fellow) or post-training physician. This educational program evaluation was determined to be “not research” for federal standard 45 CFR part 46 and 21 CFR part 56 by the Stanford Institutional Review Board (protocol IRB-68797).
RESULTS
Of 383 current (180) and past (203) Pegasus members, 81 (24%) responded (Table 1). Participant demographics are as shown (Table 2). Seventy-five percent of physicians and 50% of medical learners reported publishing 376 creative writing pieces. Respondents reported that participation improved their ability to translate experiences into stories (77%), enhanced their self-confidence as a writer (81%), improved their ability to produce creative works (78%), and improved skills in literature analysis and providing feedback (74%). The vast majority reported that participation supported writing experimentation (89%) and half reported better understanding of the publication process (51%). Most participants were also able to explore their personal and/or professional identity through program participation (78%). Most reported positive impact on their personal wellness through participation (81%), and participants felt a greater sense of community with other writers (91%).
Table 1.
Impact of Pegasus Program Participation
| Total population (n = 81) n (%) |
In training (%) (n=20) n (%) |
Out of training (%) (n=61) n (%) |
|
|---|---|---|---|
| Creative expression | |||
| Improved my ability to translate experiences into stories | 62 (76.5) | 15 (75.0) | 47 (77.1) |
| Improved my ability to analyze literature and provide feedback | 60 (74.1) | 16 (80.0) | 45 (73.8) |
| Improved my ability to plan and produce creative works | 63 (77.8) | 15 (75.0) | 48 (78.7) |
| Improved my understanding of fundamental elements of writing (structure, voice, diction, point of view, etc.) | 49 (60.5) | 11 (55.0) | 38 (62.3) |
| Creative publication | |||
| Better understood the publication process | 42 (51.9) | 11 (55.0) | 31 (50.8) |
| Experimented in my creative work | 72 (88.9) | 19 (95.0) | 53 (86.9) |
| Creative communication | |||
| Felt a sense of community among writers | 74 (91.4) | 17 (85.0) | 56 (91.8) |
| Explored my personal and/or professional identity | 63 (77.8) | 18 (90.0) | 45 (73.8) |
| Enhanced my self-awareness or self-confidence as a writer | 66 (81.4) | 15 (75.0) | 51 (83.6) |
| Creative wellness | |||
| Positively impacted my personal wellness | 67 (82.7) | 18 (90.0) | 49 (80.3) |
| Helped me reflect on my clinical practice | 54 (66.7) | 17 (85.0) | 37 (60.7) |
| Found satisfaction with my clinical work | 32 (39.5) | 11 (55.0) | 21 (34.4) |
| Increased my sensitivity to and empathy for the patient experience | 43 (53.1) | 14 (70.0) | 29 (47.5) |
| Enhanced my teaching contributions | 41 (50.6) | 8 (40.0) | 33 (54.1) |
Table 2.
Demographic Characteristics of Survey Respondents
| Characteristic | Total population (n = 81) n (%) |
In training (%) (n = 20) n (%) |
Out of training (%) (n = 61) n (%) |
|---|---|---|---|
| Years of participation (average, SD) | 5 (3.5) | 3 (2.2) | 5 (3.5) |
| Level of training | |||
| Medical student | 9 (11.1) | 9 (45.0) | – |
| Resident physician | 5 (6.2) | 5 (25.0) | – |
| Fellow | 6 (7.4) | 6 (30.0) | – |
| Practicing physician (completed training) | 61 (100.0) | – | 61 (100.0) |
| Practice setting | |||
| Academic medical center (including VA) | 50 (61.7) | 17 (85.0) | 33 (54.1) |
| Large non-academic medical center | 6 (7.4) | 0 (0.0) | 6 (9.8) |
| Community institution | 5 (6.2) | 1 (5.0) | 4 (6.6) |
| Healthcare industry | 3 (3.7) | 1 (0.0) | 2 (3.3) |
| Solo or group private practice | 2 (2.5) | 0 (0.0) | 2 (3.3) |
| Government | 2 (2.5) | 0 (0.0) | 2 (3.3) |
| Other | 6 (7.4) | 1 (0.0) | 5 (8.2) |
| Primary position at Stanford | |||
| Yes | 41 (50.6) | 13 (0.0)* | 28 (45.9)* |
| Specialty or planned specialty | |||
| Psychiatry | 18 (22.2) | 5 (25.0)* | 13 (21.3)* |
| Pediatrics | 10 (12.3) | 2 (10.0)* | 8 (13.1)* |
| Primary care | 9 (11.1) | 1 (5.0)* | 8 (13.1)* |
| Neurology | 8 (9.9) | 6 (30.0)* | 2 (3.3)* |
| Surgery | 4 (4.9) | 2 (10.0)* | 2 (3.3)* |
| Radiology | 3 (3.7) | 0 (0.0)* | 3 (4.9)* |
| Palliative care | 3 (3.7) | 0 (0.0)* | 3 (4.9)* |
| Emergency medicine | 3 (3.7) | 0 (0.0)* | 3 (4.9)* |
| Pulmonary medicine | 2 (2.5) | 0 (0.0)* | 2 (3.3)* |
| Other | 17 (21.0) | 2 (10.0)* | 15 (24.6)* |
| Published creative work | |||
| Yes | 56 (69.1) | 10 (50.0)* | 46 (75.4)* |
| Total number of published creative works after joining Pegasus | 376 | 84 | 292 |
*P<0.05 comparing in training and out of training proportions by Fisher’s exact test
DISCUSSION
Pegasus has created a growing ecosystem of physician writers which promotes physician creativity. Participating practicing physicians and medical learners published hundreds of creative writing pieces, felt part of a larger creative writing community, improved their wellness, and improved their skills in creative writing competency domains.
While our response rate is like other voluntary physician surveys,7 respondents may have been positively biased towards our program. As such, we focused our survey questions on proximate outcomes of personal wellness, development as a writer, and publication, rather than around impact on direct patient care. Follow-up participant surveys could assess participation impact on clinical practice, barriers/facilitators to publication, and the types of publication that writers chose to pursue.
Writing ecosystems such as Pegasus may help improve wellness, decrease burnout, build communities, and contribute to public discourse around healthcare topics and the patient/physician experience.
Acknowledgements
We would like to dedicate this paper to Pegasus founder, Dr. Hans Steiner, for his remarkable work in bringing together an interdisciplinary group of physician writers and collaborators, and stimulating rich dialogue and passion around creative writing (Hans Steiner, MD, 1951–2022).
Author Contribution
The authors’ contributions were as follows: JP, TKA, and MS formulated the data plan and methods; JP, TKA, AJ, and MS conducted the data analysis; JP, TKA, SS, AJ, MB, and MS wrote the manuscript; all authors revised for the manuscript; JP, TKA, and MS have primary responsibility for final content; and all authors read and approved the final manuscript.
Data Availability
Data supporting this study are included within the article and/or supporting materials.
Footnotes
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Data Availability Statement
Data supporting this study are included within the article and/or supporting materials.