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in-House: Adding Language to Experience in Graduate Medical Training

On behalf of Pager Publications, Inc. and the staff of in-Training, we are proud to announce the official launch of in-House, the online magazine for residents and fellows. in-House aims to build a community for new physicians as they navigate the monumental transitions in learning and personal growth in their graduate medical education.

The in-House editorial board will be led by editors-in-chief Dr. Joshua Liao and Dr. Jarna Shah. Josh is a fellow at the University of Pennsylvania School of Medicine and Jarna is an anesthesiology intern at the University of Illinois at Chicago College of Medicine. We invite our readers, contributors and supporters to explore in-housestaff.org, and share the publication with their resident and fellow colleagues.

Dr. Liao introduces the new publication with this following piece:

In his classic work, Letters to a Young Poet, the Austrian author Rilke implores young writers in their craft:

“Depict your sorrows and desires, your passing thoughts and beliefs in some kind of beauty –depict all that with heartfelt, quiet, humble sincerity; and use to express yourself the things that surround you, the images of your dreams and the objects of your memory. If your daily life seems poor, do not blame it; blame yourself, tell yourself that you are not poet enough to call forth its riches; for to the creator there is no poverty and no poor or unimportant place.”

This is the charge of every writer: to use words to shine light on experiences that are known by many but verbalized by few. For physician-writers in particular, it can be especially salient given the nature of our work.

There are many shared experiences among medical trainees: things joyous, hilarious, sorrowful, frustrating, perplexing, and fulfilling; things of patients and of ourselves; things about the experience of taking care of sick people that frequently go unspoken because so many of us understand them without word. And yet there are many other things ripe for saying and describing, corners of the medical profession that could be examined with the spotlight of language.

In one sense, the effort is a matter of calling. In passing his wisdom down to younger writers, author Dan Solomon puts it this way:

“Despite every advancement, language remains the defining nexus of our humanity; it is where our knowledge and hope lie. It is the precondition of human tenderness, mightier than the sword but also infinitely more subtle and ultimately more urgent. Remember that writing things down makes them real…and, most of all, that even in our post-postmodern era, writing has a moral purpose.

With twenty-six shapes arranged in varying patterns, we can tell every story known to mankind, and make up all the new ones — indeed, we can do so in most of the world’s known tongues. If you can give language to experiences previously starved for it, you can make the world a better place.”

This is heady advice. As doctors we give energy, time, and youth to the effort of making the world a better place. We pursue this goal along a number of different trajectories — clinical care, policy, community outreach, education, and more — but do so out of a common motivation.

In line with this, our goal at in-House is to support writing as another such trajectory. We aim to help our colleagues “make things real” as they write them down in order to give substance to important moments and lessons in their work. If experience generates the questions we must live with, writing helps teach us how to best live through them.

Beyond being a calling, this is also a matter of practicality. The power of the pen has been well described and a growing body of empirical evidence suggests that narratives and written communication can play important roles in communicating important health messages to target audiences. Whether in supporting policy change, community collaborations, health disparities, management and leadership, or medical humanities, writing and journalism can be an effective way to make a positive impact.

This means that beyond impressionistic narratives, we also hope to feature a wide range of other types of articles on in-House: pieces about medical education, health policy, quality improvement and patient safety, career development, and so forth. We want to share and learn about everything from new guidelines from professional societies to policy changes that will affect health parity to important elements of medical education reform. By highlighting resident and fellow leaders writing on a diverse range of important topics, in-House strives to be a hub that supports key areas of professional and career development.

Of course writing from a physician perspective is not without danger. Because of the nature of our work, it must be guided by strong ethics that protect patients, physicians, and the clinical experience. It must also be fair and even-handed. Balancing all of this can be a delicate process, but one we take very seriously at in-House.

We have committed to doing so across a range of topics and formats not because it’s expedient or easy. We know how challenging the task is, and how little extra time and energy residents and fellows have. Rather we do so because ultimately, “there is no poor or unimportant place” in graduate medical training, only ones that await illumination by those “twenty-six shapes arranged in varying patterns,” molded by the voices of young physician writers, done in the name of better health and health care.

We hope you’ll join us in producing and learning from this important work.