Fifty-five word stories are narrative tools that promote reflection and can easily be incorporated into teaching and practice.
Fifty-five word stories are “brief pieces of creative writing that use elements of poetry, prose, or both to encapsulate key experiences in health care”(Fogarty, 2010, p.400). These “small jewels” prompt personal reflection and aid in teaching. Initially created in 1986 by Steve Moss, this ultra-short genre gained traction in health education and examples have been published in numerous journals, including the Journal of the American Medical Association (Nguyen, 2018), Family Medicine (Fogarty, 2010) and Military Medicine (Laverty, 2017). Fifty-five word stories have been incorporated into undergraduate and graduate medical education, interprofessional settings, and with patients. Because they often capture the emotion learners experience, they are a powerful narrative medicine and reflective tool.
Stories are part of the medical vernacular. The “History of the Present Illness” (HPI) is a highly stylized story, told in a predictable order and answering questions like location, timing, characteristics, etc. The codified nature of medical storytelling is crucial for relaying information orally; however, medical scripts often strip away the emotional salience. Fifty-five word stories allow writers to explore the emotional impact inherent in medical education and healthcare.
The task of writing a fifty-five word story is simple: think of a compelling story based on personal experience, distill it into fifty-five words, and then share it with others. After introducing the concept, writers spend ten to fifteen minutes crafting their story and another ten to fifteen minutes paring it down to exactly fifty-five words. Prompts can be helpful; for example: “I regret…”, “I see you.”, “The case that haunts me.” After writing a story, participants are encouraged, but not required, to share their stories with each other. Sharing stories may be the most impactful part of the process. The storyteller reads their piece twice, while others listen
appreciatively. Finally, a debriefing period addresses questions such as: Why 55 words? How did writing your story make you feel? How can you integrate this exercise into your clinical practice or teaching? Can you shorten your story to six words? (Stumbar, 2022) While there is not a definitive reason that the stories must be 55 words, participants comment on how the word limit forces the writer to focus on the essence of the story and adds to its poetic quality. In addition, they feel that a 55-word limit makes the assignment imminently doable during a busy day. Depending on the number of participants, the process time varies, but it takes an hour to an hour and a half for approximately 10-25 trainees.
At Emory School of Medicine, small group leaders introduced the fifty-five word story format in 2017, and it is now used in small group settings, during some clerkships, and with all pediatrics residents. The stories accompanying this piece were written by 2nd year Emory medical students, who were prompted to write about a case, or an issue related to being a medical student that has been on their mind.
About a Shooting
Witness to the atrocities of man with no defense.
I watch with frustration, admiration, and anticipation.
An enemy to one has become a patient to another.
A provider of love battling the malice of hate.
I watch his color leave.
Like rainfall on the canvas of one’s life.
We paint a new picture.
To-dos lists without end.
Emails to send. shadow shifts to attend. question banks to take. presentations to make.
Classmates doing more though, so yes to that chart review project.
Further from medicine than ever.
No vital signs taken, or treatments suggested.
I don’t have any patients and certainly not the patience for all this waiting.
His eyes were closed only partly. His locks looked fresh and new. 17, male, waiting for the
physician—his final exam. The doctor gently felt his face, “poor child.” I followed, pressing
each cheek—broken bones. Dry blood on young soft skin. Cold. “Drag racing, new car.”
Monday in the morgue; is this my future?
Married to Medicine.
I never imagined that I would get married at twenty-four.
She is difficult and demanding. A consuming relationship at its core.
They say it should get better with time.
Yet, I still feel hopeless with this partner of mine.
Although challenging, our union was designed by fate.
My trouble and peace. My foe. My soulmate.
Teenage Well Check
“You lead social history.” Excitement.
16 years old. 6 feet. Glasses. Tan. Confident. Timid.
Sports. School. Mental Health. Bullying. Alcohol. Drugs. Relationships.
“Great job. One question. You said not sexually active. Have you ever been sexually active?”
“Once. I was 12.”
“Run chlamydia, gonorrhea.”
“That’s the thing with kids, you just never know.”
Getting to know science and humanity’s baby.
Overwhelming amount of information.
Privilege to share patient’s most vulnerable moments.
Roller coaster of emotions as life goes on outside of school, and life is messy.
Complicated and straightforward.
Known and unknown.
Hopelessness in front of a broken system. Hope of making an impact.
“Hang In There”
Morning class is over. My head throbs. Fear of missing out freezes me.
I excuse myself for the afternoon.
Do people believe my pain is real?
Perfect timing – I spend six years deciding what to do with my life, then my body tells me it can’t handle doctoring.
Good thing I’ve always been stubborn.
…Parts of myself pushed to the side in the name of The Match ™
Ambitions of saving a life and changing the world…reduced to late lonely nights and bright desk lights
Prioritizing patient autonomy but relinquishing my own, in exchange for…prestige
I miss the days before this dream of mine.
The students described the process of writing fifty-five words stories as “cathartic” and “beautiful.” Sharing their stories creates bonds between the writers and strengthens their sense of connectedness. Dr. Evans has used fifty-five word stories with medical students, residents, and faculty as a reflective tool to deepen the writer’s own understanding of the challenges experienced in medicine, as well to contemplate the commonalities of practicing medicine. The stories themselves reflect key moments in healthcare practice and in professional transformation as learners become practitioners.
The authors are grateful for the support of Sarah Gruber who participated in this project. Dr. Evans is Marcus Professor of General Pediatrics and receives financial support from this chair. There is no grant support for this work. No payment or services were received from a third party for any aspect of the submitted work.
Fogarty, C.T. (2010). Fifty-five word stories: “small jewels” for personal reflection and teaching. Family Medicine, 42(6),400-402.
Laverty, R., Anvari, A., Polmear, M & Qureshi, U. (2017). 55-word stories about medical student’s clerkship experiences. Military Medicine, 182(11/12),1744. https://doi.org/10.7205/MILMED-D-17-00374
Nguyen KM. (2018). A refugee’s journey: Told in 55-word stories. JAMA. Aug 14;320(6):551. doi: 10.1001/jama.2018.10827. PMID: 30120481.
Stumbar, S.E., Phan, M., Gomez, D.F., Earnhardt, T. Andrade, L., Hughes, P., & Mir, M.H. (2022). Letter to the editor: Six-word stories offer a new opportunity for medical students’ reflection. PRiMER, 3/25/22. https://doi.org/10.22454/PRiMER.2022.644399
Hughes Evans MD, PhD
Professor in the Department of Pediatrics, Emory University School of Medicine, firstname.lastname@example.org
Morgan Buchanan, MPH
Medical students, Emory University School of Medicine