Epiphany. Insight. The “Eureka!” effect. These moments of sudden comprehension—times when “it all comes together”—are vital to learning and discovery. And yet, as psychological constructs, epiphanies and insights are not well understood, not easily measured, and generally not captured in typical journal articles that describe phenomena or report results in the indexed scholarly literature.
But the process of becoming a doctor involves—perhaps requires—many such moments that bring coherence, suddenly and strikingly, to disparate beliefs, experiences, and dilemmas. In fact, it may not be possible to learn how to become a physician absent these epiphanies and insights.
Of course, epiphanies are not limited to sudden realizations of how facts and knowledge fit together. Some epiphanies are crucial to developing a more sophisticated understanding of what it means to be a professional person, to be moral, to be compassionate, or even what it means to be born or to die. Furthermore, an epiphany can facilitate emotional growth, psychological development, and professional and personal maturity.
For the last ten years, the column in this journal called Teaching and Learning Moments (TLM) has provided a venue for recording such epiphanies, lessons, and insights. Between January 2002 and December 2011, the journal published 159 stories of learning and discovery, of reflection and self-revelation.
These stories have been written by faculty members, residents, and students and cover a broad range of ideas, topics, and pivotal moments. TLM essays range from descriptions of key experiences that illuminate why the author chose to pursue medicine as a career to incidents that affirm the importance of knowing the patient as a person. Some essays expose how patients teach physicians the most important lessons they will ever learn, some illuminate the stress of handling a new level of patient responsibility, some highlight the difficulty and importance of getting the complete story from the patient, and some uncover the deeper meaning of disability, suffering, and pain. The TLM columns deal with oaths and vows, competence and humility, communication and trust, and missed diagnoses and misdiagnoses. Themes that weave their ways through many of the column’s essays include professionalism, duty, altruism, ethical dilemmas, and cultural determinants of sickness and healing.
Mary Beth DeVilbiss, senior staff editor, edited TLM for five years. She enjoyed editing the column “because, more than any of the journal’s other article types, TLM essays are highly personal reflections that offer a window into how everyday events touch and shape the authors of these short essays.” She observes that the essays tell stories about important aspects of the informal and hidden curricula when she notes that they describe “events that mean more for the authors’ development as physicians, teachers, and leaders than the curricula and competencies that shape their professional and educational trajectories.” Mary Beth also points out the potential restorative value of TLM essays for the journal’s readers as they “pause between studies reporting on outcomes for populations to reflect on a singular experience.”
Toni Gallo is the staff editor who took the reins from Mary Beth and currently edits the TLM column. Toni feels that the column is special because “while the ‘moment’ depicted is personalized to each author, many of the lessons are universal and connect readers to the author, since they can relate to the author’s experience.” Toni says that she came to appreciate the essence of what it means to be in a medical school or teaching hospital “by working with authors who were telling meaningful and personal stories that were firsthand accounts of real situations in medical schools and teaching hospitals.” For Toni, the TLM column is described best by a few lines from the play The History Boys by Alan Bennett:
The best moments in reading are when you come across something—a thought, a feeling, a way of looking at things—which you had thought special and particular to you. Now here it is, set down by someone else, a person you have never met, someone even who is long dead. And it is as if a hand has come out and taken yours.
To commemorate its tenth anniversary, the 159 TLM essays published in the journal between January 2002 and December 2011 will be reproduced in an eBook, complemented by commentaries by Rita Charon, MD, PhD, and by Maren Batalden, MD, MPH, and Elizabeth Gaufberg, MD, MPH. Both commentaries also appear in this issue of the journal. In addition to being enjoyable reading, this eBook will be useful to prospective TLM authors as they think about their own stories and how to build on the very valuable lessons revealed by these short essays over the last decade.
And so, please join the journal’s editorial staff and me in celebrating the TLM column as it enters its second decade. The column continues to thrive because the human memory is built to remember the interesting case, the exceptional event, the memorable moment.
And speaking of such cases, events, and moments, when they happen to you—and when they are particularly noteworthy for their teaching or learning value, are instants of especially insightful reflection, or are extraordinary moments of transformation in learning, growth, or development—please consider submitting your story as a TLM essay.
Steven L. Kanter, MD