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Letters to the Editor

First-Year Students Need Time to Grieve

Kolberg, Kristen; Malik, Aroosa

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doi: 10.1097/ACM.0000000000002074
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To the Editor:

We agree with Drs. Cohen and Chandra,1 who wrote in a recent Letter to the Editor of the importance of creating space for grieving the loss of patients during physician training; however, we believe that discussions around patient loss and coping with the resulting grief should begin far before residency.

Preclinical education is heavily focused on diagnostic reasoning and creating a foundation of medical knowledge. While this foundation is necessary, the focus on learning material to improve test scores leaves little room for processing emotions or the feeling of vulnerability. Meanwhile, physician burnout—reported to affect as many as 54% of U.S. doctors2—has been on the rise. Emotional challenges can occur even in the first year of medical school as students adjust to the workload, deal with unexpected life events, face mortality through the window of many illnesses, and manage personal experiences with disease.

Fortunately, our first-year class had an opportunity to reflect on these difficult experiences through a course titled “The Healer’s Art.” The course is offered at many institutions around the country, is taught by physicians to learners at all stages of training, and covers topics such as “sharing loss and honoring grief” and “the care of the soul.”3

Many of our classmates in Healer’s Art expressed difficulty with seeing histopathology images or discussing symptoms of diseases that their family members had experienced. Providing resources and a space to reflect on emotions with fellow students can promote wellness and create a sense of community. We feel this course will help us become more emotionally competent and avoid burnout during our careers as physicians. Furthermore, hearing experienced physicians reflect on their own experiences with patients helped normalize the idea that practicing doctors wrestle with loss and grief; if senior faculty experience these challenges, students should not feel weak when they struggle with questions of death and mortality.

We suggest that more medical schools incorporate programs such as Healer’s Art that allow students to acknowledge grief early in their careers. Providing education on processing emotional situations will teach students how to better navigate stresses and, in turn, make them better prepared for residency and practice.

Kristen Kolberg
Second-year medical student, University of Michigan Medical School, Ann Arbor, Michigan; ORCID:; e-mail:; Twitter: @kkolberg22.

Aroosa Malik
Second-year medical student, University of Michigan Medical School, Ann Arbor, Michigan; ORCID:


1. Cohen ME, Chandra S. The time to grieve: A difficult question in medical training. Acad Med. 2017;92:580–581.
2. Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work–life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc. 2015;90:1600–1613.
3. Remen RN, Rabow MW. The Healer’s Art: Professionalism, service and mission. Med Educ. 2005;39:1167–1168.
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