Residents' Retreat

For the past twelve years Department of Humanities at Pennsylvania State University College of Medicine has conducted an overnight retreat for an interdisciplinary group of residents to explore humanistic dimensions of medicine and of the residency experience itself. The retreat has three main goals: to create a setting in which residents can explore complex and personally challenging aspects of their professional development; to combine intellectual intensity with emotional openness and increased self-awareness; and to lay the foundation for follow-up activities at Penn State Milton S. Hershey Medical Center that build on the participants' experiences at the retreat. We invite two residents from each of the programs at the medical center (one each from the various surgical subspecialties). Usually they are residents who will assume chief resident positions the following year, so they will have major responsibilities for education and supervision of the other residents in their programs. Between 14 and 18 residents have attended each year. We also include four or five senior clinical faculty, who participate as discussion leaders, role models, and mentors. By arrangement with each program director, the residents' schedules have been cleared and rendered beeperless for the duration of the retreat, which runs from 9:00 A.M. Thursday to noon Friday.

The retreat takes place at a conference center located about 45 minutes from the medical center geographically, but much farther psychically. It is in a lovely rural setting with woods, meadows, and a rushing trout stream. We meet in May. Dress is casual and some sessions are held outside. Discussions are intense, but there is also time for quiet reflection by the stream, a run before dinner, and a good night's sleep. The size of the group, the setting, and the pace of the retreat permit an extraordinary rapport to develop. This in turn allows us to probe some of those issues that by their nature resist being plugged into the typical conference format. These include:

It is not that these topics are never addressed in the ordinary medical center milieu. But it has been our experience that some of the more profound and personally challenging dimensions of these issues are much less likely to surface there. When we address them at the retreat, we ask one of the senior clinical faculty to begin each session by recounting how he or she has experienced the particular issue, both as a resident and as an attending physician. This approach encourages the residents to participate actively, since the attending has not only "broken the ice," but has also legitimated the residents' expression of their own uncertainties, concerns, or emotions. A few short and provocative readings, distributed in advance, provide further common ground.

Each session runs for an hour and a half, but the discussions often flow into the break periods and on into meals. Common themes--e.g., the experiences of uncertainty and vulnerability, the ubiquity of moral concerns in patient care, the importance of open communication, and the need for supportive peers and attendings--appear and reappear throughout the various sessions, leading to richer and subtler understandings as the retreat proceeds. We schedule the session on dying patients (predictably the most profound and emotionally intense) after breakfast on the second day. Somehow the accumulation of shared meals and spending the night prepares people to trust each other with a degree of emotional and intellectual honesty that seems to emerge only rarely in other academic or professional settings.

An Alternative Format: The Residents' Retreat