To the Editor:
Plews-Ogan and colleagues1 identify eight themes for positive coping with medical error. They note that, of the eight themes, forgiveness was particularly challenging, and that physicians need help in reworking their narrative to achieve posttraumatic growth and move towards wisdom. We are grateful that these authors delineate the problem and provide useful recommendations for peer support programs. They suggest that “Fostering opportunities for self-forgiveness, without the perceived cost of lowering standards, deserves attention in peer support programs.”1 We agree and recommend that these strategies also become part of the wellness and professionalism curricula during undergraduate medical education. As medical educators can attest, students struggle with forgiving themselves for poor exam performances, for “not knowing enough” in their clerkships, etc. This raises at least two questions: Are students actually interested in forgiveness? Are there quick effective self-forgiveness tools that can be utilized across the medical continuum?
In a medical humanities seminar at Oakland University William Beaumont School of Medicine, second-year students select 3 out of 20 potential topics in mind–body medicine to aid in formulating seminar content. Interestingly, despite such options as psychedelic medicine, acupuncture, and placebo/nocebo, the most popular selection was anger/forgiveness (13/24 students). In addition, 3 of these students specifically wrote their reflection paper on the topic of forgiveness. While anecdotal, these data indicate that students are open to and interested in forgiveness as it relates to patient health and self-care.
We suggest that self-reflection tools be made available online to augment any in-person peer support or counseling. However, quick and simple evidence-based self-forgiveness frameworks appear lacking. In an ongoing study here, participants listen to a short guided intervention to promote self-forgiveness. Preliminary data based on three different forgiveness scales indicate it is highly effective; for example, in response to the postintervention statement “As I consider what I did that was wrong, I have forgiven myself,” which was anchored at 1 = not at all and 10 = completely, the average score was 7.7 (n = 17, SD = 1.2).
We are excited that this self-forgiveness framework could be utilized across the medical continuum. While it is perhaps professionally “unwise” to offer this tool prior to full publication, our view is that student and physician wellness is too important to await completion of our study, and, like the authors, we wish to “create an environment that fosters continuous learning and improvement, teamwork, relational care, compassion, and wisdom.”1
Thomas Michael Ferrari, PhD
Assistant professor, Department of Biomedical Sciences, Oakland University William Beaumont School of Medicine, Rochester, Michigan; firstname.lastname@example.org.
Angela Nuzzarello, MD, MHPE
Associate dean for student affairs and associate professor of psychiatry, Department of Biomedical Sciences, Oakland University William Beaumont School of Medicine Rochester, Michigan.
1. Plews-Ogan M, May N, Owens J, Ardelt M, Shapiro J, Bell SK. Wisdom in medicine: What helps physicians after a medical error? Acad Med. 2016;91:233241.