Thoughts that breathe, and words that burn: poetic inquiry within health professions education

“Poetry is thoughts that breathe, and words that burn”

Thomas Gray

Poetry is a vehicle for human meaning making. It is part of everyday life which, if you look, you’ll find in advertisements, music, even sports cheers. It is not a modern fascination—indeed, poetry likely predates written text [1]. Before humans documented their experiences in a written format, poetry was an integral part of communities’ oral cultures, used to pass knowledge, history, and stories between generations [2]. Poems condense human experience, and when this experience speaks to you in some way, poetry feels meaningful and important [3]. Given the innate resonance of poetry to the human condition, poems feature within higher education, too. Within health professions education (HPE), poems have been most typically integrated into curricula within medical humanities modules as a way of centering patient narratives, engendering empathy amongst trainees, and facilitating reflective practice [4‐6]. Several medical and medical humanities journals publish authors’ poems as arts contributions, demonstrating an appetite for poetry as a creative outlet in HPE. Yet, despite the pertinence of poetry to human experience, poetry as a form of research has not been a central topic of HPE conversation. In this article we introduce readers to poetic inquiry and its potential to expand qualitative research within HPE. We start by offering a broad definition of poetic inquiry, consider why it is both necessary and well suited to the field, and situate our exploration within phenomenology. We then progress to outline some approaches to engaging with poetic inquiry and illustrate these approaches using examples from HPE scholarship. Finally, we invite interested readers to consider ways in which they could engage with poetic inquiry, or to consider ways in which they could poetize their existing qualitative research practices.

Poetic inquiry is an arts-based research methodology which treats poetry as a ‘vital way to express and learn’ by incorporating original poetry into academic research [7, 8]. Though there is no consensus definition, ‘the key feature of poetic inquiry is the use of poetry as, in, [or] for inquiry’ [9], with poetic inquiry employed in diverse ways by researchers to collect data, collect field notes, and represent and reinterpret data [7]. The approach is gaining traction in many social science disciplines, including sociology, psychology, anthropology, and education [10]. Reasons for the use of poetic inquiry include preservation of participant voice [7], to explore the relationship between language and meaning [11, 12], to deepen researcher reflexivity [13], and to increase the emotive impact and accessibility of academic research [14] as poetic inquiry can help both researchers and audiences engage more deeply with participant accounts [15]. Additionally, through its attention to language, poetic inquiry is a rigorous approach—it allows ‘thoughts [to] breathe’—whilst also promoting an emotive efficiency of qualitative expression which helps ‘words [to] burn’. Yet, despite the benefits poetic inquiry can offer qualitative research, it has not received the same degree of focus or enthusiasm within HPE.

Creative deviation from specific analytic qualitative processes is not the norm within HPE. Though approaches such as phenomenology, which seeks to represent the rich and complex nature of participants’ lived experiences [16], are becoming increasingly important within HPE, there has been a move to solidify processes of analysis to demystify the practice, and so increase rigor [17]. Whilst an important consideration, we believe the pendulum of data analysis is in danger of swinging too far—from openness to fixity—and qualitative research is at risk of stagnating. Several scholars have noted that qualitative inquiry often tends towards the descriptive, with deep thought regarding the connections between data, and the meaning of these connections wanting [17, 18]. Such deep thought is necessary for approaches which seek to represent the complexity of experiences, such as within interpretative phenomenology [19]. Others have argued that servile adherence to one’s data through a rigid set of analytic steps leaves no time or space for moments of ‘wonder’, surprise, or the emotional responses of the researcher that facilitate rich engagement and interpretation [20‐22]. Being bound too heavily by methodological processes represses the imaginative creativity of qualitative expression and interpretation that has traditionally been a cornerstone of the approach [23, 24]. As we amass increasing levels of knowledge regarding topics such as professional identity formation within HPE, rich, creative qualitative exploration is necessary to advance scholarship in the field and expand understanding regarding the nuances of the process. New ways of scrutinizing old problems may also help further knowledge [25]. We propose that poetry through the medium of poetic inquiry may offer one way in which to restore creativity and deep engagement with qualitative data to qualitative inquiry within medical education.

As an approach, poetic inquiry is broad and diverse. Scholars have situated their engagement with poetic inquiry within a variety of different qualitative traditions such as phenomenology [26], participatory action research [27], ethnography [28], narrative inquiry [29] and performative inquiry [30]. We suggest that, within HPE research, poetic inquiry finds a natural home as part approach of phenomenology.

Indeed, poetry is essential to phenomenological thought [31]. For Heidegger, thinking is something which only occurs in the company of, or with poetry [32], Van Manen refers to phenomenology itself as a ‘poetizing project’ [26], whilst Bachelard used poetry to consider the meaning and impact of physical spaces [33]. As researchers immerse themselves in the construction of poetry from data, they open themselves to ‘what is said, or more accurately to what is unsaid’ [32], a necessary condition to unconcealing phenomena which, for interpretative phenomenologists like Heidegger, is synonymous with truth [34, 35]. As Galvin and Todres surmise, ‘poetic language emphasizes ‘wholeness’, in that, through rhythm, repetition, and imagery, a wholeness is pointed to that is more than what is there’ [36]. In this way, poetic inquiry facilitates an openness to ‘the otherness of language’ [32], and acts as a way of thinking about one’s data in a way that engenders moments of wonder, and stimulates deep, analytical thought. Whilst at the heart of phenomenology is a commitment to represent experience ‘well’, all too often this is taken by medical educationalists as a mandate to retell events as they are reported by participants, instead of utilizing phenomenological inquiry to open a space of understanding. Phenomenological accounts are not always factual—they can, and often do, draw upon fictional accounts to create ‘anecdotes of experience’, which convey meaning that is hard to communicate using a language of facts [37]. Creating poems as part of phenomenological inquiry can be seen as a way of creating these ‘anecdotes of experience’. For Van Manen, the key requirement of an ‘anecdote of experience’ is that the experiential account—in the case of poetic inquiry, the poem—is plausible in its truth-value [37]. Good phenomenological writing means that the reader recognizes the plausibility of the experience, even if they have never personally experienced that moment or kind of event. This is referred to by Van Manen as ‘the phenomenological nod’, where the reader of an account nods in agreement as they read about the lived experience of others [38].

Poetic inquiry may also help combat the oversimplification of findings within phenomenological research, which Sass comments is a key danger of phenomenological study [39]. Phenomenologists must constantly strive against reductionist portrayal of their findings—as Kelly et al. posit ‘phenomenology seeks to represent human experience in all its complexity, rather than seeking to reduce, parse or operationalize it’ [40]; this can cause issues when scholars are faced with journal-mandated word counts for their qualitative research. Portraying one’s data as poetry is an efficient way of displaying results within a qualitative paper’s results section, without (if done carefully, as we will discuss below) succumbing to reductionism. The necessity of ‘razor sharp’ language in short poems can powerfully capture the human experience in fewer words than with traditional qualitative quote display [41]. As Tse suggests, poetic inquiry ‘works with rather than against the complexities of experience, which researchers are always mining for understanding that is not easily extrapolated’[42]; simply put, poetic inquiry efficiently communicates a study’s findings whilst conserving their complexity. Poetic inquiry may, therefore, go some way to countering the temptation of reductionism in regard to phenomenological research.

Given the alignment of poetic inquiry to hermeneutic (interpretative [43]) phenomenological traditions, and its potential to counteract some of the issues phenomenological researchers may encounter, poetic inquiry has been used within phenomenological inquiry within other branches of the academe [13, 26]. Within HPE, poetic inquiry is similarly suited to use within a phenomenological approach.

One can engage in poetic inquiry in many ways. Van Luyn et al. draw distinctions between participant-voiced poetry, autobiographical poetry, and research poetry [44]. These approaches to poetic inquiry are summarized in Tab. 1. In sum, participant-voiced poetry (sometimes referred to as ‘vox participare [10]’, ‘found poetry’ [11] or ‘data poetry’[45]) is the practice of creating a poem ‘solely from primary sources’ such as interview transcripts or written reflections [46]. The researcher shapes a participant’s words, ‘re-present[ing]’ them in poetic form [47]. Autobiographical poetry (sometimes referred to as auto-ethnographic poetry [45], or ‘vox autobiographica [10]’) is what one might expect—the construction of autobiographical poems that explore the experience of the researcher, ‘in order to gain insight into a particular research process’ [44, 48]. Research poetry (or ‘vox theoria [10]’), is sometimes classed as a subtype of autobiographical poetry. However, Van Luyn et al. class research poems as a distinct entity, drawing attention to the fact that they are literature-voiced poems, written specifically in response to literature or theory in a field [44]. Whilst they are created by a researcher, they are ‘not a direct expression of the researcher’s personal experience’ [44].

Van Luyn et al.’s review suggests that participant-voiced poetry is the most common form of poetic inquiry [44]. There can be significant variation within this approach. Whilst we aim to cast some light on possible ways of engaging in participant-voiced poetic inquiry, the approaches we outline are by no means comprehensive or singular and are not intended to act as a prescriptive ‘how-to guide’. We outline two approaches to participant-voiced poetry: 1) Glesne’s method of poetic transcription and 2) Gilligan et al.’s listening guide, drawing on examples from HPE to illustrate their use.

Though the benefits of poetry may appeal, researchers may not wish, or have capacity to, dive head-first into the unknown waters of poetic inquiry. If this is the case, there are several ways in which one can engage in ‘methodological borrowing’ [59] to poetize more traditional qualitative research projects and develop as a poet gradually over time [60]. Reflexive and analytic journaling is common within qualitative research. Researchers could expand this practice to include poetic journaling, an approach where researchers begin to think poetically about their findings. No two poetic journals will look the same. Researchers may wish to read poetry, taking notes on impactful lines and phrases which make them think. Researchers may also begin to write poems about their data and position as a researcher, experimenting with participant phrases, their own thoughts, and poetic conventions like rhyme and form. Keeping a poetic journal may also help capture what the sociologist Mills terms ‘fringe thoughts’—ideas which are by-products of everyday life, and which we usually dismiss as ‘mental noise’ but can hold intellectual value relevant to data analysis and theorization, as they prompt us to think differently about our research [61]. Excerpts from poetic journals could also be included within research manuscripts to demonstrate the process of reflexive engagement researchers have undertaken throughout a project. Using Gilligan’s listening guide as part of one’s analysis, but not results representation, may help researchers begin to think poetically about their data, and develop their poetic ear, without fear of their poetic output being subject to wide scrutiny.

There is debate within the poetic inquiry community as to what qualifies one to use poetic inquiry, with some concluding that, to engage in poetic inquiry, one should be a published or formally trained poet in their own right [58]. Respectfully, we disagree. Though proponents may claim their views are to protect the reputation of poetry, and ensure quality inquiry, such views position poetry as an elitist pursuit which prevents the engagement of novice, but keen, would-be poetic researchers. Given the benefits of poetic inquiry, we join with Lahman and Richard in advocating for ‘good enough’ research poetry [62]. ‘Good enough’ poetry is the space between the belief that ‘any person may write poetry’ (we recognize you need a grounding in poetic inquiry, and an appreciation of the approach), and ‘the scholarly belied that in-depth training is needed’ [62].

This debate may leave you feeling uneasy. As health professions educators, we enjoy practical guidance. If you are wondering how you will know whether your poems are ‘good enough’, we suggest you turn to Sullivan’s 2009 architectural dimensions of a poem [63] for reassurance, which Pate has synthesized into a quality checklist [26] (summarized in Table S2 of the Electronic Supplementary Material). As previously, these are not the only markers of poetic quality, nor do we believe they should be used prescriptively. Sullivan’s dimensions interplay and exist as a complex web or nexus that influence the impact and resonance of a poem. We advise that where researchers wish to use this checklist, they frame it as a broad guide or reflexive tool to consider the steps taken within their own research projects carefully and critically. Additionally, as researchers open up the possibilities of the method, it may be beneficial to learn more about typical poetic conventions such as form, meter and rhyme to advance your craft—but this is no means a prerequisite, at least in our eyes, to the ability to produce ‘good enough’ participant-voiced poetry.

Though qualitative research is increasingly valued, barriers still exist to the progression of qualitative research within HPE. Discussions of the quality of qualitative research have centered methodological rigor, an important concern, but one that has dominated conversation. The threat to qualitative creativity has been much less frequently discussed within HPE. Poetic inquiry has not been a central topic of conversation yet holds the potential to encourage researchers to think deeply and creatively about their findings. Poems emphasize language and may cast new light on areas of HPE where thinking has become narrowed. Poetic inquiry can foster increased researcher attention to reflexivity in a creative and contemplative way. Crucially, poetic inquiry can preserve participant voice within research reports, and may offer one way to represent experience more faithfully. Poetic inquiry has much to offer HPE, and we encourage researchers to take up the poetic mantle to diversify research within the field and cultivate creativity. For, to return to the words of the poet Thomas Grey, who would not wish their thoughts to breathe, and words to burn?