Dr. Batalden is senior medical director of inpatient quality, Cambridge Health Alliance, Cambridge, Massachusetts, and instructor in medicine, Harvard Medical School, Boston, Massachusetts.
Dr. Gaufberg is director, Center for Professional Development, Cambridge Health Alliance, Cambridge, Massachusetts, and associate professor of medicine and psychiatry, Harvard Medical School, Boston, Massachusetts.
Correspondence should be addressed to Dr. Gaufberg, Cambridge Health Alliance, 1493 Cambridge St., Cambridge, MA 02139; e-mail: email@example.com
Editor’s Note: This commentary commemorates the 10th anniversary of Academic Medicine’s Teaching and Learning Moments feature.
There are two kinds of intelligence: one acquired, as a child in school memorizes facts and conceptsfrom books and from what the teacher says, collecting information from the traditional sciences
as well as from the new sciences.
With such intelligence you rise in the world. You get ranked ahead or behind othersin regard to your competence in retaininginformation. You stroll with this intelligencein and out of fields of knowledge, getting always more
marks on your preserving tablets.
There is another kind of tablet, one already completed and preserved inside you. A spring overflowing its springbox. A freshness in the center of the chest. This other intelligence does not turn yellow or stagnate. It’s fluid, and it doesn’t move from outside to inside through conduits of plumbing-learning.
This second knowing is a fountainheadfrom within you, moving out. - — “Two Kinds of Intelligence” by Jalal al-Din Rumi1
Although Rumi1 crafted the poem “Two kinds of intelligence” in the 13th century, his words are arrestingly contemporary. In academic medicine we are rich with facts and concepts and sincere in our quest for information from what Rumi calls “the traditional and the new sciences.” We are busy with assessment of competencies and occupied with rankings. But what of this second kind of intelligence—the spring overflowing its springbox? What is its place in academic medicine? How do we find it? How do we harness its power for action?
Rumi’s “second knowing” often speaks in the first person. In print, tucked among the rigorous research reports detailing advances in sciences traditional and new, it often takes the form of a brief essay, like the reflections in the Academic Medicine feature Teaching and Learning Moments (TLM). In each column, a writer—a medical student, a resident, a junior or senior physician faculty member, an occasional nonphysician educator—tells us something that matters. The narratives are epiphanies, confessions, expressions of gratitude or lament, statements of intent or belief, parables. They are short, demonstrating poetic economy of language. They are emotionally evocative. Most are born of experience—the first time, the time I was the patient, the time I got it wrong, the time I got it right, the time I was surprised by looking through different eyes.
Almost always, the narrator is the protagonist in these autobiographical tales and the narrator wants us to know that he or she is changed. The narrator has learned, or remembered, something true. We readers don’t question the statistical significance of that truth. We know its significance belongs to a different domain. The stories run against the grain, offering a powerful counter narrative within the culture of academic medicine. Our individual and collective knowledge is built incrementally through carefully and rationally accumulated evidence to be sure, but sometimes understanding widens unpredictably in quantum leaps when we just open our hearts and minds. This second kind of intelligence—the words of the poet resonate—is “already completed and preserved inside.”
The second knowing flows like a river through the practice of clinical medicine. Every day, our work invites us to bear witness as human beings encounter their own humanity—loss, recovery, grief, hope, isolation, companionship, vulnerability, resilience. The moments highlighted in TLM columns are everyday moments in every medical school, in every residency program, in every clinic, in every hospital. These moments become extraordinary and personally transformative only when we pay attention. And paying attention is surprisingly difficult. Though this second kind of intelligence endures—Rumi asserts that it does not yellow or stagnate—it does not, cannot force itself into our awareness.
Writing about these moments honors them; writing invites the writer to deepen his or her attention and in so doing invests these moments with more transformative power. The silence created by the myriad untold stories, however, is deafening. Many times these stories go untold because the protagonists don’t even notice these stories unfolding around them (“Water?” asks the fish, “What the hell is water?”2). The stories we do read are disproportionately told by newcomers to the culture, by students and residents who see and hear with beginners’ eyes and ears. Over time, our senses dull and our capacity for sense-making—a capacity Rita Charon3 has termed “narrative competence”—can wane. Telling and listening to these stories wakes us up; it makes the familiar strange and the strange familiar.
But it is not just simple familiarity that blinds us to the power of these moments over time. The dominant culture in academic medicine highly values Rumi’s first kind of intelligence; ours is largely an acquired-intelligence enterprise. Our careers rise and fall based on our achievements in this domain. Perhaps something in the hidden curriculum of the culture of academic medicine even teaches us to be suspicious of our own subjective experiences. We learn to distance ourselves from anything too “touchy feely.”
The invitation to value our subjective experiences is an invitation to integrity, an invitation, as Parker Palmer4 would say, to the “undivided life.” In the undivided life, we bring our interior subjective experience—the domain Palmer calls “soul”—into alignment with our public identity—the domain he calls “role.” We respond to this invitation as clinicians when we share a genuine laugh with a patient, when we allow ourselves to feel sad, when we pull out a family picture or ask to see one. The wisdom of the dominant culture in academic medicine often counsels emotional distance as a strategy for preventing exhaustion. Ironically, we find that inviting what Palmer would call our “whole selves” to the table—a strategy which often decreases emotional distance—keeps us engaged and energized in our work. The invitation to show up with our whole selves is not limited to our clinical roles but extends to all our roles—colleague, teacher, manager, scholar, parent, partner, child.
It is good to pay attention to these moments that have so much to teach us about the meaning of our work. It is good to tell these stories to one another. They keep us sane; they call us into greater wholeness. These stories are powerful as personal vignettes. When these stories get published in journals, we can read them alone in offices behind closed doors and connect quietly with the resonant experiences of strangers. But we do not truly unleash the power of these narratives until we talk about them in community. In conversation, these personal narratives or “stories of self” have the potential to find common cause with the stories of others and become “stories of us.” Through conversation that is rooted in a particular time and place, these stories of self and stories of us are linked to a “story of now.”5 And these public narratives have the power to catalyze movements for change.
In monthly teaching sessions with medical students and residents, we use these and other personal narratives as starting points for collective reflection. Like many educators, we make space (and create mandates) for learners to tell and write stories about their experiences. Invariably, when learners come together to share stories, they find deep common ground: shared core values of kindness, human connection, and commitment to social justice; shared fears and frustrations and shame. When we do our job well in facilitating these sessions, we can see learners recognizing Rumi’s second kind of intelligence “already completed inside themselves.” We can see them beginning to realize that they are the ones they have been waiting for; that they hold the power to create the culture of their own micro-environments within medicine.
We believe, with the proponents of relationship-centered health care, that organizations—medical schools, clinics, hospitals—are more like conversations than machines.6 In health care reform efforts, payment models certainly matter, but it is also true that we bring about reform from the inside by changing what we talk about and how we talk about it. Let us pay attention, then, to our subjective experiences and honor Rumi’s second kind of intelligence. Let us come together and tell our stories to one another and tell them well, naming the core values that drive us and the forces that threaten those values. These stories have the power to show us the future we are trying to create.
Funding/Support: Dr. Gaufberg is grateful for the support of an Arnold P. Gold Foundation Professorship.
Other disclosures: None.
Ethical approval: Not applicable.
1. Rumi JBarks C. Two kinds of intelligence. In: The Essential Rumi. 1995 New York, NY HarperCollins;. Reprinted with permission.
2. Wallace DF This Is Water: Some Thoughts, Delivered on a Significant Occasion, About Living a Compassionate Life.. 2009 New York, NY Little, Brown and Company
3. Charon R. Narrative medicine: A model for empathy, reflection, profession, and trust. JAMA. 2001;286:1897–1902
4. Palmer P A Hidden Wholeness: The Journey Toward an Undivided Life.. 2004 San Francisco, Calif Jossey-Bass
6. Suchman A, Sluyter D, Williamson P Leading Change in Healthcare: Transforming Organizations Using Complexity, Positive Psychology, and Relationship-Centered Care.. 2011 London, UK Radcliffe Publishing