Beginning with the end in mind


– the retirement speech or letter as a means of teaching professionalism

For many years PRIME has used an exercise at the end of trainer training or whole person medicine courses, that involves inviting participants to write a letter that they would like to receive from their students/trainees/patients on their retirement. This ‘reflecting forwards’ exercise helps learners to articulate and personally own the values they want to express throughout their professional lives as medical practitioners and teachers, so encouraging them to put them into practice in their real working situation.

A recent article in Academic Medicine 1 provided some research evidence for the effectiveness of this kind of exercise, based on the responses of internal medicine residents in North America. The Interns composed remarks that might be used to introduce them at their own retirement ceremony following a career in medicine. This “career eulogies” exercise was introduced to groups of six interns during the first third of the internship year as part of a two-week curriculum focused on professional development. Two investigators independently coded the written introductions, identifying emergent themes through content analysis. Of the 19 interns in an internal medicine residency program (2012-13), 17 participated in the exercise. Six themes emerged from the data: aligning behaviours with core values, achieving excellence in medicine, changing the world and giving back, valuing teamwork and relationships, realising work-life balance, and appreciating a career in medicine. The authors say that these themes correlate with accepted published definitions of professionalism in medicine. The aim of teaching these is to transform a theoretical concept into an internalised and actualised identity. Many trainees struggle with professionalism in the abstract, particularly when instruction methods are didactic and disconnected from personal experience.

The authors conclude by saying that the personal reflections produced through this exercise allow physicians to begin to formulate their professional self-conception. Extensions of this work might include linking such forms of critical reflection to individualised learning plans and updating the statements over time. Further research on “reflecting forward” may determine its impact as a complement to traditional narrative reflection.

It is interesting to note that Jesus often used similar techniques in His teaching, telling stories in which the listeners could easily identify themselves as possible participants, and getting them to reflect on which actions they recognise as being in line with God’s values.

Why not get your students to write a letter they would like to receive on retirement – it should generate a fruitful discussion about which values are key to being an effective, compassionate, patient-centred clinician, and what their expression looks like in everyday practice.



One thought on “Beginning with the end in mind

  1. A very practical implementation of what Dr Ed Pellegrino proposed nearly 15 years ago as a paradigm for “internal morality of clinical medicine.” Thanks!

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