Practical Wisdom Stories as told by Medical Students and Physicians (Phronesis Narratives Project) 
Jordan Millhollin, BS, The University of Chicago, Chicago, IL; Elaine Liang, The University of Chicago, Chicago, IL; Zack Loveless, PhD, The Hyde Park Institute, Chicago, IL; Sarah Kim, BA, The University of Chicago, Chicago, IL; Laura Shinkunas, MS, The University of Iowa, Iowa City, IA; Tavinder Ark, PhD, Medical College of Wisconsin, Milwaukee, WI; Lauris Kaldjian, MD, PhD, The University of Iowa, Iowa City, IA; Fabrice Jotterand, PhD, MA, Medical College of Wisconsin, Milwaukee, WI; and John Yoon, MD, The University of Chicago, Chicago, IL

Medicine as both clinical and moral venture is increasingly complex. Stemming from worldly brokenness, competing obligations frequently vie for a physician’s time, energy, and decisions. As such, practical wisdom, the multi-dimensional meta-virtue which can help to guide actions within the complex circumstances of medical practice, is gaining increasing attention in contemporary literature. Our team’s prior study, using the responses of medical students and physicians, described practical wisdom as relevant to most or all medical decision-making, goal-directed, and associated with an additional set of cooperative virtues. As a continuation of this work, we analyzed clinical narratives to uncover the particularities of lived phronesis within clinical practice. For humans as meaning-making creatures, storytelling is a “special way of knowing” that enables the contextual conveyance of moral reasoning. As such, telling and hearing stories is vital to understanding practical wisdom as means toward “the great coherence.” Given this, our study aims to further describe the clinical contexts in which practical wisdom is required and the particular character traits which enable practical wisdom among exemplars. We performed structured interviews with 62 participants at two medical schools (40 clinical medical students and a purposive sample of 22 nominated physicians) to identify clinical situations they believe involved practical wisdom. Participants noted that practical wisdom is most commonly used in an inpatient or surgical setting, and frequently involved patient advocacy, individualized patient care, and communication. Character traits involved in practical wisdom included person-centeredness, poise, deliberativeness, goal-directedness, and context-sensitivity. Our sample consisted of volunteer students who may have been influenced by the bioethics curriculum at the two medical schools involved, so a selection bias toward student participants more interested in practical wisdom may be present. Our results indicate that clinical medical students pay attention to their attendings’ actions and identify similar components of practical wisdom as their MD counterparts. Stories about practical wisdom most often involve person-centeredness, emotional intelligence or poise, and goal-directed decision-making, especially when balancing multiple perspectives or goods. This suggests that practical wisdom is cultivated among trainees when medical students observe exemplars demonstrating these components in practice. These results also reiterate that the moral thickness of clinical medicine is such that it allows for rich stories, which is what is needed for medical (and moral) education.