Reflective Practices Among Global Health Fellows in the HEAL Initiative: a Qualitative Study

  • Zachary G. JacobsEmail author
  • Robin Tittle
  • Joseph Scarpelli
  • Karen Cortez
  • Samuel D. Aptekar
  • Sriram Shamasunder
Concise Research Reports


Working in global health is at once rewarding and challenging.1 Delivering healthcare to underserved populations can be isolating, demanding, and emotionally draining, particularly in resource-limited settings.2

Narrative medicine is defined as the practice of clinical medicine using narrative competence: the skillset necessary “to recognize, interpret, and be moved by stories of illness.”3 Teaching narrative skills to healthcare providers has been shown to foster wellbeing and reduce burnout.3, 4 One such skill, reflective writing, is most effective when explicit emotional disclosure is used.5 Global health is a potential niche for narrative training that has not been thoroughly explored.

The Health, Equity, Action, and Leadership (HEAL) Initiative is a 2-year, inter-professional global health fellowship. HEAL fellows engage in immersive clinical experiences at a variety of underserved sites, both locally and internationally. While they are encouraged to reflect about...

Key Words

global health narrative medicine reflective writing resiliency burnout qualitative research medical education 



The authors would like to acknowledge the University of California, San Francisco Academy of Medical Educators Innovations in Medical Education Grant, which will be used to fund future curricular innovations related to this study.

Compliance with Ethical Standards

Conflicts of Interest

The authors declare that they do not have a conflict of interest.


The authors report no financial disclosures.


  1. 1.
    Iserson KV, Biros MH, James Holliman C. Challenges in international medicine: ethical dilemmas, unanticipated consequences, and accepting limitations. Academic Emergency Medicine 2012;19:683–692.CrossRefGoogle Scholar
  2. 2.
    Hayashi AS, Selia E, McDonnell K. Stress and provider retention in underserved communities. Journal of Health Care for the Poor and Underserved 2009;20:597–604.CrossRefGoogle Scholar
  3. 3.
    Charon R. Narrative medicine: form, function, and ethics. Annals of Internal Medicine 2001;134:83.CrossRefGoogle Scholar
  4. 4.
    Chen I, Forbes C. Reflective writing and its impact on empathy in medical education: systematic review. Journal of Educational Evaluation for Health Professions 2014;11:20.CrossRefGoogle Scholar
  5. 5.
    Baikie KA, Wilhelm K. Emotional and physical health benefits of expressive writing. Advances in Psychiatric Treatment 2005;11:338–346.CrossRefGoogle Scholar
  6. 6.
    Fischer MA, Haley H-L, Saarinen CL, Chretien KC. Comparison of blogged and written reflections in two medicine clerkships. Med Educ 2011;45:166–175.CrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2018

Authors and Affiliations

  • Zachary G. Jacobs
    • 1
    • 2
    Email author
  • Robin Tittle
    • 3
    • 4
  • Joseph Scarpelli
    • 4
  • Karen Cortez
    • 4
  • Samuel D. Aptekar
    • 4
  • Sriram Shamasunder
    • 1
    • 4
  1. 1.Division of Hospital MedicineUniversity of California San FranciscoSan FranciscoUSA
  2. 2.Division of Hospital MedicineOregon Health & Science UniversityPortlandUSA
  3. 3.Division of Hospital MedicinePortland VA Medical CenterPortlandUSA
  4. 4.HEAL InitiativeUniversity of California San FranciscoSan FranciscoUSA

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