Fiction-Based Book Clubs: Building Empathy Through Storytelling

Podcast Transcript

Dr. Tony Tizzano:

Hello and welcome to MedEd Thread, a Cleveland Clinic education podcast that explores the latest innovations in medical education and amplifies the tremendous work of our educators across the enterprise. Hello, welcome to today's episode of MedEd Thread, an education podcast exploring how fiction-based book clubs in medical education serve a means for developing critical emotional awareness and a better understanding of the holistic patient experience and wellness among learners. I'm your host, Dr. Tony Tizzano, Director of Student and Learner Health here at Cleveland Clinic in Cleveland, Ohio. Today, I'm very pleased to have Loren Hackett, Medical Librarian at the Cleveland Clinic's Hillcrest Hospital, here to join us. Loren, welcome to the podcast.

Loren Hackett:

Oh, thank you for having me.

Dr. Tony Tizzano:

Also with us today is Michelle Kraft, Director of Library Services for Cleveland Clinic Health System. Michelle, thank you for joining us today.

Michelle Kraft:

Thank you. It's great to be here.

Dr. Tony Tizzano:

So Loren and Michelle, to get us started, could each of you please tell us a little bit about yourselves, your educational backgrounds, what brought you to Cleveland and your respective roles here within the Cleveland Clinic Health System?

Loren Hackett:

Sure, I'll start. This is Loren. I had a background in technical writing and information organization and thought that that segued really nicely into librarianship. And I had some scientific jobs here and there. And so that kind of parlayed well into medical librarianship. And so here I am, I've been at Cleveland Clinic since late 2016, which is amazing. And I've had a really wonderful time working with everyone throughout the clinic. We've done library service work for everyone from environmental services to spiritual care to surgeons and administrators, so it's been really great.

Dr. Tony Tizzano:

Fabulous. We enjoy your hard work and we need it so much now, more than even ever. Michelle, what about you?

Michelle Kraft:

Well, I'm a bit of an old-timer. I've been with Cleveland Clinic since 1998. I originally got my degree in medical librarianship at the University of Missouri, and I saw a job for Cleveland Clinic and I thought I'd come here and become a medical librarian. And I've kind of just stayed here. I've evolved from entry-level baby librarian to the director of the Cleveland Clinic Health System Libraries.

Dr. Tony Tizzano:

Fabulous. And more than that, for our listeners, she's also served as the president for the Medical Librarians Association nationwide. So we both appreciate in this day and age, your jobs and roles have changed so much, and this is kind of a new venue for us. So in today's segment, we will explore how fiction-based book clubs serve as a powerful educational tool by promoting critical thinking, fostering a love of literature, and improving social skills through collaborative discussion. Also, these have been an engaging way for enhancing empathy, reducing physician burnout, and fostering narrative medical skills. So Loren, to get us started and help frame today's topic, could you provide our listeners with some context around the growing role of fiction-based book clubs and what sparked your interest in this novel adjunct to medical education?

Loren Hackett:

Sure, so I will say this was actually an idea brought to me by a caregiver at Hillcrest Hospital who wanted to talk about books in a way that would bring together caregivers from throughout the hospital in different roles to build empathy and think about what the people who are coming into the hospital might be bringing with them as they come through our doors for care, and maybe not even just patients, but also what our colleagues are bringing as well. And so we started this book club just for Hillcrest folks to come together, and then in the last year, we expanded it to include anyone across the Cleveland Clinic system who might be interested in talking about the human experience with their colleagues.

Dr. Tony Tizzano:

You know, I think that's a really interesting point. We have no idea what our patients might be reading, but a lot of it is healthcare related. And so to have book clubs that kind of parlay off of that notion is really a nice way for us to have kind of a broader understanding of what our patients come to us with. Michelle, when you look at the impact these clubs might have from a health systems perspective, as you oversee your work throughout the entire healthcare system at Cleveland Clinic, what are your thoughts?

Michelle Kraft:

Well, I think they offer employees a non-formal setting for learning. It offers like a low-stakes reflective learning environment that touches on both professional development, but culture and patient care. And a lot of the topics that we will be looking at in some of these books explore moral distress, uncertainty, grief, identity. And these are topics that medical professionals often experience, but they rarely process in a formal way.

Dr. Tony Tizzano:

Do you think that going even beyond that, there's an opportunity to even sort of have some cultural change within an institution based on bringing these books from perhaps a metaphorical standpoint?

Michelle Kraft:

Absolutely.

Loren Hackett:

Yeah, definitely. For example, one book we read a few years ago talked about the main character was struggling with addiction. And we talked not only about the character in the book, but also what if this man had come in as a patient? What if this was our family member? And being able to use the book as an entrée into that bigger conversation was really valuable.

Michelle Kraft:

And I think that book clubs offer a way of tackling these challenging social issues because everybody's engaged as the reader. It's just not a certain type of profession. It's not just doctors, it's not just nurses. You have cross-disciplinary discussions. So you start to understand and respect each other's perspectives, which builds relationships and community. It fosters learning. And I think it stimulates a culture of change.

Dr. Tony Tizzano:

Yeah, I couldn't agree more. And I think the other important point is that coming together and talking through things flattens the hierarchy.

Michelle Kraft:

It does.

Dr. Tony Tizzano:

It's very psychologically safe. It's not physician, nurse, patient. It's all of these people one-on-one who have never come together before. They may not even know each other's roles. And so you're on a level playing field. And I think that's really important. So Loren, building on Michelle's comments, might fiction-based book clubs provide a strategy for these tough conversations and address issues within our organization that might not be so politically correct just to bring out? And can we ask questions to raise important points projecting onto fictional characters and situations?

Loren Hackett:

Oh yeah, definitely. I think as we just mentioned, it gives you a launching pad for those conversations that doesn't point fingers back at anyone in the room. It gives you sort of a, almost a metaphorical way to have a conversation without having it in a tough way. And it also helps bring people together who might not have originally been able to have that conversation. Two people who aren't going to pass each other in the hallway are now sitting down with room to breathe around the conversation. And so these book topics and experiences can help foster so much growth by challenging ideas we might have had without encountering this topic or these other folks who are reading the book with us. And I think ultimately that builds really healthy work environments because we're building those interpersonal relationships.

Dr. Tony Tizzano:

Well, I love it. Michelle, what are likely benefits of this form of non-formal learning environment compared to the continuing medical education courses that all healthcare workers are required to do?

Michelle Kraft:

Well, you know what's interesting is there's actually been some studies on book clubs. Robin Grenier, a professor of adult learning at UConn's Neag School of Education, and Neag School PhD alumni Christy Cappell have shown that book clubs function as non-formal learning environments that build on prior knowledge while fostering critical thinking. Book clubs can create a more pleasant learning environment. And again, like I said earlier, they create a low-stakes learning experience. You have more participants who are willing to engage with each other, which leads to greater retention of material than formal professional development. And it helps contribute to shifting perspectives. We see outside of our own bubble. So our roles in the healthcare system, we see other roles as well. And then it can connect themes from the fiction or the work of the literature to their own clinical experiences and reinforcing and extending what they already know. And then it allows us to explore and question assumptions as we consider multiple perspectives without that single quote-unquote right answer. So we're always essentially fostering these critical thinking skills. And it's the heart of this discussion that is the important process. It's the heart of the learning process.

Michelle Kraft:

Grenier and her co-authors point out book club discussions can be intentionally tied to the workplace and professional practice, where the act of literacy can be interwoven with organizational themes as members of book club align with institutional priorities and practices.

Dr. Tony Tizzano:

Yeah, I love it. It's almost like we can play with the hypothetical, and since we're playing with the hypothetical or the fictional, we're allowed to talk about it and we can speak freely.

Michelle Kraft:

Absolutely.

Dr. Tony Tizzano:

So Loren, expanding on potential precepts further, how might fiction book clubs promote critical public pedagogy by encouraging participants to question existing systemic structures of society, such as popular media, civic spaces, social movements, and public intellectuals?

Loren Hackett:

Well, I think that book club members can use texts and then the subsequent discussions around those to learn how to work through and reflect on and then ultimately address the social or political issues that are encountered in our lives. And that extends from home to the workplace or out in general society. I think it's really important when we're reading to read books about people who have experiences that are wildly different from our own. And that can help us empathize better with someone whose life experience is completely different from ours and see why, "Oh, the system is serving me. It's not really serving you." And then it can also help people develop their critical thinking skills because they're having to work through these ideas that challenge the beliefs they've held maybe for their entire lives. And then finally, I would say that engaging in book clubs reminds us that teaching and learning and growing are not just restricted to, I sit in a classroom, I learn from a teacher, I do my homework. We can learn and grow and teach every day in any setting.

Dr. Tony Tizzano:

Yeah, I couldn't agree more. And as adults, and actually from childhood on, as we gather years and we understand our language better, we actually learn better through verbal communication than any other means. And so taking what you've read, bringing that into a conversation among a group from all kinds of perspectives can really be a growth experience. So Michelle, considering all these elements collectively, what is the potential for cultural growth or organizational change through these fictional titles?

Michelle Kraft:

I think this is where it gets really interesting. To me, book clubs aren't just about reading. They become a space where people actively work through real-world issues that they're facing, whether it's in their clinical work or their organization or even in their personal lives. They're connecting the book to their own experiences and hearing how their colleagues interpret the same situations. And that kind of shared reflection really matters. It can lead to greater understanding and empathy for others who have identities or experiences that are different from their own. And when readers are willing to stand in another person's shoes, these book clubs can become a space for engaging that cultural and organizational change work.

Dr. Tony Tizzano:

Yeah, I think those are all very important. And I think for institutions, that's why we see support for it within our own organization. So Loren, I'm beginning to see that book clubs are really a powerful, low-cost adjunct to medical education capable of fostering these humanistic values that we so much desire, enhance empathy, and potentially reducing burnout among trainees and professionals. What are key ways that book clubs might function as educational tools?

Loren Hackett:

Sure. So there are a few different ways I think we can look at book clubs and what they can bring to the table. So first of all, and I think this has come up, empathy, empathy, empathy, right? Promoting narrative medicine and an empathetic approach to the people we encounter.

Michelle Kraft:

I think it's more than just empathy for the patient. It's empathy for the family of the patient.

Loren Hackett:

Yes.

Michelle Kraft:

Empathy for the people who are caring for the patient, who love the patient as well. Understanding how those things go. I don't think we always, when we're talking about patient care, extend that type of care beyond the patient.

Loren Hackett:

Yeah, that's a really good point. And even the person who drove the patient to the appointment, the people who are at home depending on that patient. And the narratives that we encounter in book clubs can remind us of that. And beyond that, I think that book clubs can also develop professionalism and increase the self-reflection skills that people have. We can help drive reflective practice and help people navigate the ambiguity of tricky professional and interpersonal experiences.

Dr. Tony Tizzano:

Yeah, I think that is a really powerful area because reflection wasn't something I encountered in my training. And this whole notion, it's so important in our College of Medicine at Lerner that students reflect and then write about the conversations and classes we've had and kind of share their own perspective. But it's just taking time to go back and say, how does that resonate with me? Or how did I change my idea based on what I heard other people say? That is such an important thing. And it really requires that we listen. So often we're ready to formulate a response, but this really forces us to listen. So I like that point in particular. What about mentorship and connection among professionals?

Loren Hackett:

Oh yeah, absolutely. I think book clubs sort of help level the playing field, right? If you're a hospital administrator or my coworker who sits next door, we're all coming to the table to talk about the same book and everyone's opinions are as valid as the next. And I think that that can bring people together in a really wonderful way. There's no worries about, am I going to say the wrong thing? Am I going to bring the wrong thing to the table?

Michelle Kraft:

It's a learning environment in which there is no student and teacher.

Loren Hackett:

Yes.

Dr. Tony Tizzano:

Excellent point. Excellent point.

Michelle Kraft:

Yeah. So there is the opportunity for discussion without the concern about that hierarchy.

Dr. Tony Tizzano:

And I think the surprising thing probably oftentimes is you never know who's going to end up leading some facet of that conversation. And so perhaps it's even a way that we develop a leadership skill in someone that you didn't expect to do it because they came from, who knows, from food services. And now you're listening to them talk about something they're passionate about and you're thinking, wow, you get some accidental leaders.

Michelle Kraft:

And I say accidental leaders as people that step up that you didn't automatically think of as a leader based on whatever their role is. But in the book club, they become the leader because they're either passionate, like you say, or they're knowledgeable in an area that you aren't knowledgeable about. And so it's helpful to have somebody lead in an area that you're unaware of.

Loren Hackett:

And likewise, you may walk away from the book club saying, "Wow, I learned a lot about myself in that I really have some wisdom on this topic." And that can also increase self-confidence.

Michelle Kraft:

Absolutely.

Dr. Tony Tizzano:

What about professionalism in non-medical reading? Is there a value there?

Loren Hackett:

Yeah, I think it's always important to be curious about topics outside your area of professionalism or even your area of just what piques your curiosity. And so I think that when we ask healthcare folks to read books outside what's expected of them in their curriculum, it can help break that routine and give them fresh perspectives. And also, I don't even think we've talked about work-life balance yet in this and what book clubs can bring to make sure we're taking a little bit of time to step away from the grind and use a different part of our brains.

Michelle Kraft:

And there's that really old phrase, "All work and no play makes Jack a dull boy." You need that work-life balance. You don't want to be focusing on one area too long. You want to be a well-rounded individual to have perspectives from everything. And the book clubs offer that and allow us to not focus in any one area all the time. We can expand our horizons.

Dr. Tony Tizzano:

In having those conversations and bringing them even to the clinical setting with patients, they start to see you as something more than just a clinician with this technical side. They get to see you as a person and you get to see them as a person.

Michelle Kraft:

You become more real to them.

Dr. Tony Tizzano:

Absolutely. And it certainly wasn't my quote, but I read somewhere along the line looking into this that reading books and reading patients are interconnected skills.

Loren Hackett:

Oh, I love that. Yeah.

Dr. Tony Tizzano:

I think that is so true. It just widens our perspective that we need to draw all of this in.

Loren Hackett:

Yeah. I will also say, and as someone who is not a clinician, but who sees so much of the background work done around patient care, I think that the art of medicine is such a beautiful phrase for how complex it is to take care of people and why not complement the art of medicine with the art of writing and reading?

Dr. Tony Tizzano:

Absolutely. I've had patients say to me so often, my husband came in and he's a welder. He felt so out of place in the labor room, but all of a sudden he realizes, I love that kind of technical stuff. So I'm bending his ear about welding. Before you know it, when you start engaging him in his area, he's willing to ask you questions. So absolutely, it starts to flatten the hierarchy.

Michelle Kraft:

It spans all educational levels too. It can be somebody like a welder, but then it can also be somebody who doesn't have a lot of education, or likewise, it can be like my father, who was an engineer and designed aircraft. When he went in for his doctor's appointment, the doctor he really engaged with best was the person who said, wait, you're an engineer? And he said, yes. And he goes, my son's an engineer. I just know now how to rephrase everything and explain things from an engineering standpoint to him.

Dr. Tony Tizzano:

Yeah, perfectly stated. So both of you, Loren, Michelle, what lies on the horizon for organizers and participants of fiction-based book clubs as they seek to optimize the impact of these in a very increasingly popular endeavor?

Loren Hackett:

There are just so many different ways to bring book clubs into your experience if you're interested. They hold the promise of moving beyond simply being an instrument of trainee and employee learning to a means of critical consciousness raising within organizations. There are leadership book clubs, fiction-based book clubs, and ours is a mix. You can bring in different groups of people. Ours is based on Cleveland Clinic employees, but you could invite community members.

Michelle Kraft:

I think some people also get hung up on the idea of, "Oh, I've got to read a book." There's audiobooks. On your morning commute, something different to listen to. It gets you thinking in a different way. I've been listening to audiobooks while commuting with my son, and we've had great discussions.

Loren Hackett:

And I would also add that if you've not read the book or finished the book, you can still engage meaningfully with others and learn from their takeaways.

Michelle Kraft:

Not every book is for everybody. But trying the book matters.

Loren Hackett:

This is two librarians giving you permission to not finish a book. Just try it.

Dr. Tony Tizzano:

When you listen to a book, you don't skip. It forces you to listen.

Michelle Kraft:

Absolutely.

Dr. Tony Tizzano:

I'd also like to highlight upcoming podcast episodes tied to your book club selections.

Dr. Tony Tizzano:

Well, Loren and Michelle, thank you both so much. This is an intriguing and wonderfully insightful podcast. To our listeners, if you would like to suggest an educational topic or comment on an episode, please email us at education@ccf.org. Thank you for joining us. This concludes this episode of MedEd Thread. Be sure to subscribe via iTunes, Google Play, Stitcher, Spotify, or wherever you get your podcasts. Until next time, thanks for listening.