Reigniting Your Curiosity During Fellowship

As an early faculty member in oncology at Vanderbilt University Medical Center (VUMC), I had the pleasure of seeing a new patient in one of our more rural community clinics. In our initial 1-hour consultation, I learned that she had gone to school in a 1-room schoolhouse without running water; she hated potatoes because they had eaten them for every meal growing up; and that she was an excellent cook because she had raised her many younger siblings. Amazed, I left that visit and found another colleague immediately, excitedly recounting all these incredible details about her life.

When we consider how an oncologist derives meaning from their work, it is clear that we find deep satisfaction in knowing the data inside and out; from working collaboratively with colleagues; and from delivering care that is equitable and efficient. For me, although these elements are important, it is the discovery of the seemingly small details of a patient’s life that enrich the experience most. Although cancer is deeply important to their lives, it is not overly interesting–they did not choose it for themselves. In fact, it interrupts the things that are interesting: hobbies, spending time with family, travel, work, religious practices, and service. For me, discovering these pieces of a patient are what bring meaning to the encounter.

To fully understand the “thickness” of a patient’s narrative, as Rita Charon, MD, PhD would put it,¹ I would argue that we must remain genuinely curious about the human being in front of us. Who are their people? What are they proud of? How do they spend their time? What do they value? These are the questions that I encourage my trainees to ask when we are seeing a new patient, and they are the same questions that I ask in my own clinic visits.

And yet curiosity is hard! The wonderful Faith Fitzgerald, MD, argues that genuine curiosity is at risk in our trainees, in part due to the structure of modern medical education and in part due to the demands for efficiency in our health system.² Nevertheless, it remains key to knowing our patients; she argues that curiosity “converts strangers (the objects of analysis) into people we can empathize with. To participate in the feelings and ideas of one's patients—to empathize—one must be curious enough to know the patients: their characters, cultures, spiritual and physical responses, hopes, past, and social surrounds.”

However, curiosity requires time, a luxury that can be difficult to come by for trainees. The vast amount of ever-expanding knowledge one must learn, coupled with long hours and little personal control, married with a demanding medical system, and topped off with the pressures of caring for a critically ill and vulnerable population can be a recipe for burnout—and a subsequent loss of curiosity.

So, what is the dedicated oncology fellow to do? I would argue that the conscious, deliberate practice of narrative medicine can reignite our curiosity about others. Narrative medicine is an academic framework dedicated to “understanding patients’ lives, caring for the caregivers, and giving voice to suffering.”³ In practice, it encourages learners to flex their analytical muscles with “close reading” of art, music, and literature–learning how to critically assess these works by asking questions about the details, narration, point of view, feelings, and direction of the piece. These same skills may then be applied to patient stories and encounters, to understand the human being sharing their illness narrative.

At VUMC, we have done this work more formally through a longitudinal graduate medical education certificate program in the medical humanities that I co-direct with my colleagues Chase Webber, DO, and Katie Van Schaik, MD, PhD. Trainees from intern to fellow are welcomed from across the institution and come together over the course of a year to do flash writing, close reading of art and literature, collection of patients’ oral histories, and discussion of their own works. Recognizing that there are specific needs for our oncology fellows, I also run similar seminars quarterly for the fellowship program. In these sessions, I challenge fellows to close read a poem, or take 5 minutes to respond to a prompt, or to discuss the first patient story that comes to their mind. By using pre-protected conference time, we give the space that allows our trainees to get curious (again) about their patients. I ask them the “whys” about their stories. Why did the patient say that? Why did you feel frustrated during this encounter? Why do you think they declined to take chemotherapy?

However, not all fellows are at institutions that have this kind of programming readily available. Below are some of my favorite tips for engaging with narrative medicine that do not require formal programming.

Megan’s Tips for Developing Narrative Competence:

1. Keep a journal (in general). I keep a small, leather-bound journal in my bag or white coat pocket. When something funny, or sad, or bizarre happens with a patient, I write it down. The key here? It does not need to be the next Great American Novel. Many of us are inhibited by our desire to be perfect – why write something down if it is not immediately publication-worthy? But this is not the point. The point of maintaining a daily journal is to practice reflection.
2. Keep a death journal (specifically). For each patient that I have cared for who has passed away, I keep an entry in this journal. Who were they? What were the names of their pets and family members? What did they love to do? How did they make me feel? These small reflections are a way for me to mourn, to remember them, to love them 1 final time. At the time of this writing, I have more than 100 entries in my journal.
3. Practice close reading on anything! Columbia University has an excellent framework for how to do close reading.⁴ I like to challenge myself to close read a piece of art at a museum, a new song from an album I love (Noah Kahan, anyone?), a lengthy Instagram post (what was the motivation for this influencer to write this caption? What are the points of view expressed? Do I believe him?), or even a story a colleague is telling me (how do I think it made her feel? How did it make me feel?). These small exercises make it easier to seamlessly do the same when I am working with my patients.
4. Practice writing about patients. Sometimes, I will expand 1 of my journal reflections into a longer piece. Other times, I will use a writing prompt to get the creative juices flowing and will just wait to see what bubbles up! If a piece feels important enough, I will submit it for publication. For example, I published a piece about my oncology practice during fellowship.⁵ This practice allows me to continue to be reflective about specific patients, but also about my general habits as an oncologist.

I will conclude with this question: When you went into medicine, what kind of doctor did you imagine that you would be? I had always imagined that I would be a gatherer of stories; I wanted to be able to contextualize complex medical choices within the fabric of each patient’s life. If this is similar to who you thought you’d be, then I think narrative medicine as a means to engage with patients is absolutely the practice for you! And who knows, it may just reawaken your spirit of curiosity.

References

1. Charon R, Charon R, Ebook Central Academic C. The principles and practice of narrative medicine. Oxford University Press; 2017.
2. Fitzgerald FT. Curiosity. Ann Intern Med. 1999;130(1):70-72. doi:10.7326/0003-4819-130-1-199901050-00015
3. Krisberg K. Narrative medicine: every patient has a story. Association of American Medical Colleges. March 28, 2017. Accessed May 3, 2026. https://www.aamc.org/news/narrative-medicine-every-patient-has-story
4. Charon R, Hermann N, Devlin MJ. Close Reading and Creative Writing in Clinical Education: Teaching Attention, Representation, and Affiliation. Acad Med. 2016;91(3):345-350. doi:10.1097/ACM.0000000000000827
5. Dupuis MM. Tamales. J Clin Oncol. 2025; 43 (15): 1839-1840. doi:10.1200/JCO-25-00091