why do we study creative writing

Why Learn Creative Writing?

Sean Glatch | November 1, 2022 | 5 Comments

Why learn creative writing? Truthfully, creative writing is one of the most misunderstood disciplines in the 21st century. When people think of a creative writing course, they often imagine a group of lofty, out-of-touch people who wear argyle sweater vests and have unproductive conversations about abstract concepts.

In reality, nothing could be further from the truth: the best writing classes remain engaged with the real world, and the skills gained in a creative writing course apply to nearly every facet of daily life.

If you’re wondering whether it’s worth picking up a course in fiction, nonfiction, or poetry, we have five reasons to learn creative writing. But first, let’s talk about what actually happens in a creative writing course.

The Basics of a Writing Workshop

Whether you’re enrolled in a poetry, fiction, or nonfiction writing class, you can expect the following writing process – at least in a quality writing course like the ones at Writers.com.

Weekly prompts and writing exercises to sharpen the precision and necessity of each word you use.
Constructive critiques from a community of writers who are each growing their writing skills alongside you.
A creative space to explore new ideas, experiment with language, and arrange words in new and exciting ways.
Focused writing instruction from a master of the craft.

The benefits of creative writing come from engaging with the course material, the writing prompts, and the other class members. These elements help you become a better writer, both in creative realms and in everyday life. How? No matter what form of writing, a creative writing class pushes you to connect ideas and create effective narratives using the best words – and that skill translates into real world success.

The Benefits of Creative Writing

1. why learn creative writing: improved self-expression.

Improving your writing skills leads to stronger communication. When you practice finding the right word in a story or poem, you engage the same parts of your brain that are active in everyday writing and speaking. A creative writing course subconsciously turns you into a more effective communicator.

The importance of precise language and self-advocacy translates well into both interpersonal relationships and working environments. Take it from this expert on how writing and self-advocacy results in career and leadership success.

2. Why Learn Creative Writing: Job Success

This brings us to our next point: great writing leads to job success. Of course, your boss probably isn’t expecting you to write emails in the form of a short story or a sonnet – though if they are expecting this, you have a pretty cool boss.

In reality, almost every job requires some sort of written work, whether that’s simple written communication or something more elaborate, like publishing data or marketing materials. In a creative writing class, you practice the style and grammar rules necessary for effective writing, both within the realms of literature and in career-related writing. Sharpening your writing and creativity skills might just land you your next promotion.

3. Why Learn Creative Writing: Improved Thinking Skills

Strong writing leads to strong thinking. No matter what type of writing you pursue, learning how to write is another form of learning how to think.

That might seem like a bold claim, so think about it this way. Without language, our thoughts wouldn’t have form. We might not need language to think “I’m hungry” or “I like cats,” but when it comes to more abstract concepts, language is key. How would you think about things like justice, revenge, or equality without the words to express them?

When you hone in on your ability to find choice, specific words, and when you work on the skills of effective storytelling and rhetoric , you improve your ability to think in general. Good writing yields great thinking!

4. Why Learn Creative Writing: Empathy

Reading and writing both rely on empathy, especially when it comes to being an effective workshop participant. When we read and write stories, we situate ourselves in the shoes of other people; when we read and write poetry, we let language navigate us through emotion.

The importance of creative writing relies on empathy. We practice empathy whenever we listen to another person’s life story, when someone tells us about their day, and when we sit down with a client or work partner. When we write, we practice the ability to listen as well as to speak, making us more effective communicators and more compassionate human beings.

5. Why Learn Creative Writing: It’s Fun!

In case you’re not convinced that a writing course is right for you, let’s clarify one more fact: creative writing is fun. Whether you’re in a fiction writing course, starting a memoir, crafting a poem, or writing for the silver screen, you’re creating new worlds and characters. In the sandbox of literature, you’re in control, and when you invest yourself into the craft of writing, something beautiful emerges.

The Importance of Creative Writing

Simply put, creative writing helps us preserve our humanity. What better medium to explore the human experience?

To learn creative writing, like any art form, requires compassion, contemplation, and curiosity. Writers preserve the world as they observe it in stories and poetry, and they imagine a better world by creating it in their works.

Through the decades, literature has explored society’s profound changes. Literary eons like the Naturalist movement and the Beat poets responded to the increase in Western Industrialization. Confessional poets like Virginia Woolf helped transform poetry into a medium for emotional exploration and excavation. And, genre movements like the cyberpunk writers of science fiction helped popularize the idea of an “information economy.”

Thus, the importance of creative writing lies in its ability to describe the world through an honest and unfiltered lens. Anyone who engages in creative writing, no matter the genre or style, helps us explore the human experience, share new ideas, and advocate for a better society. Whether you write your stories for yourself or share them with a wide audience, creative writing makes the world a better place.

Jobs for Creative Writers

Because creative writing isn’t a STEM discipline, many people don’t think that learning it will help their job prospects. Why learn creative writing if it doesn’t make any money?

In fact, nothing could be further from the truth. Creative writing skills are much sought after on resumes, since both creativity and the ability to write are soft skills in decline. Additionally, if you’re considering a career change—or ready to start one!—these are some popular jobs for creative writers.

Average Starting Salary: $51,000
Demand: High
Skills needed: creativity, grammar, timeliness

Copywriters help companies put their branding into words. A copywriter might write emails, blogs, website content, or ad copy that encompasses the company’s voice and purpose. Copywriting requires you to write in a mix of styles and forms, flexing your writing muscles in new and exciting ways.

Grant Writer

Average Starting Salary: $50,000
Skills needed: storytelling, research, argumentation

Nonprofits and research facilities rely on local and national grants to fund their projects. Grant writers help secure that funding, writing engaging grants that tell the organization’s story in an engaging, tailored, and convincing way. Creative writers will enjoy the opportunity to tell a meaningful story and create positive community change through this career.

Communications/Public Relations Specialist

Skills needed: creativity, communications, social media

A communications specialist helps drive a company’s image through various social channels. They may help create a positive narrative for their company through blogs, journalist outreach, social media, and other public-facing avenues. Much like copywriting, a PR specialist helps weave an effective story for a company.

Average Starting Salary: $55,000
Demand: Medium/High
Skills needed: creativity, storytelling, organization, self-reliance

The dream job for many writers is to write and sell books. Being a novelist is an admirable career choice—and also requires the most work. Not only do you have to write your stories, but you also have to market yourself in the literary industry and maintain a social presence so that publishers and readers actually read your work. It’s a tough business, but also incredibly rewarding!

Reasons to Learn Creative Writing: Finding a Writing Community

Finally, creative writing communities make the writing struggle worth it. The relationships you foster with other creative writers can last a lifetime, as no other group of people has the same appreciation for the written word. Creative writing communities create transformative experiences and encourage growth in your writing; if there’s one reason to study creative writing craft, it’s the friendships you make in the process.

You don’t need a class to start writing, but it’s never a waste of time to learn the tools of the trade. Creative writing requires the skills that can help you in everyday life, and a creative writing course can help.

At Writers.com, we believe that creative writing can transform both individual lives and the world at large. See the importance of creative writing for yourself: check out what makes our creative writing courses different , then take a look at our upcoming course calendar today.

Sean Glatch

Would like to apply for a course to write a novel.

I’d be happy to help! Please email [email protected] with any questions, and we’ll find the right course for your writing.

[…] Sean. “Why Learn Creative Writing.” writers.com. June 7, 2020. https://writers.com/why-learn-creative-writing . Accessed November 7, […]

[…] And last of all it’s fun! I hope to live my life doing the things I love, with like-minded creative people who I love. I have many exciting things upcoming as I continue with the process of completing my first novel, Les Année Folles, such as publishing to my first magazine, journal, and working on the millions of short story ideas I have stored in my head. Stay tuned! References: Glatch, S. (2020, June 7). WHY LEARN CREATIVE WRITING? Retrieved from Writers.com: https://writers.com/why-learn-creative-writing […]

Creative Writing: What It Is and Why It Matters

By: Author Paul Jenkins

Posted on Published: January 13, 2023 - Last updated: January 15, 2023

Categories Writing

Writing can be intimidating for many people, but creative writing doesn’t have to be. Creative writing is a form of self-expression that allows writers to create stories, characters, and unique settings. But what exactly is creative writing? And why is it important in today’s society? Let’s explore this further.

How We Define Creative Writing

Creative writing is any form where writers can express their thoughts and feelings imaginatively. This type of writing allows authors to draw on their imagination when creating stories and characters and play with language and structure. While there are no boundaries in creative writing, most pieces will contain dialogue, description, and narrative elements.

The Importance of Creative Writing

Creative writing is important because:

It helps us express ourselves in ways we may not be able to do with other forms of communication.
It allows us to explore our creativity and think outside the box.
It can help us better understand our emotions by exploring them through storytelling or poetry.
Writing creatively can also provide much-needed escapism from everyday life, allowing us to escape into a world of our creation.
Creative writing helps us connect with others by sharing our experiences through stories or poems they can relate to. This way, we can gain insight into other people’s lives while giving them insight into ours.

Creative Writing: A Path to Mental and Emotional Wellness

Writing is more than just a way to express your thoughts on paper. It’s a powerful tool that can be used as a form of therapy. Creative writing has been shown to improve emotional and mental well-being.

Through creative writing, we can gain insight into our emotions, develop self-expression and communication skills, cultivate empathy and understanding of others, and boost our imagination and creativity.

Let’s examine how creative writing can relieve stress and emotional catharsis.

Stress Relief and Emotional Catharsis

Writing has the power to reduce stress levels significantly. Writing about our experiences or about things that are causing us anxiety or distress helps us to release those complicated feelings constructively. By expressing ourselves through creative writing, we can work through the emotions associated with stressful situations without having to confront them directly.

This is especially helpful for people who struggle to share their emotions verbally or in person.

Improved Communication and Self-Expression

Creative writing is also beneficial for improving communication skills. Through creative writing, we can explore our thoughts and feelings more intensely than by speaking them aloud. This allows us to think more clearly about what we want to say before actually saying it out loud or in written form, which leads to improved self-expression overall.

Additionally, writing out our thoughts before speaking aloud allows us to articulate ourselves better when communicating with others—which is essential for healthy personal and professional relationships.

Increased Empathy and Understanding of Others

Through creative writing, we can also increase our empathy towards others by exploring different perspectives on various topics that may be unfamiliar or uncomfortable for us—such as racism, homophobia, sexism, etc.—and allowing ourselves the opportunity to see the situation from someone else’s point of view without judgment or bias. This helps us become better communicators and more understanding individuals overall.

The Professional Benefits of Creative Writing

Creative writing is a powerful tool that can help you communicate better and more effectively in the professional world. It can also help you develop various skills that prove invaluable in many industries. Whether you’re looking to build your résumé or improve your communication, creative writing can effectively achieve both.

Let’s take a closer look at how creative writing can benefit your career.

Preparing Students for Careers in Writing, Editing, and Publishing

Creative writing is the perfect foundation for anyone interested in pursuing a career in writing, editing, or publishing. It teaches students the basics of grammar and composition while allowing them to express their ideas in imaginative ways.

Creative writing classes also allow students to learn from professionals who have experience as editors, agents, and publishers. They can use this knowledge to learn creative writing, refine their craft and gain valuable experience before entering the job market.

Improving Skills in Storytelling and Marketing for Various Careers

Creative writing teaches students to think critically about stories and craft compelling narratives that draw readers in. This skill is precious for those who wish to pursue careers outside traditional writing roles—such as marketing or advertising—where storytelling is key.

People who understand the fundamentals of creative writing will be able to create persuasive copy that resonates with readers and effectively conveys a message.

Enhancing Team Collaboration and Leadership Skills

Creative writing isn’t just about expressing yourself through words; it also provides an opportunity to practice working collaboratively with others on projects. Many creative writing classes require students to work together on group projects, which helps them develop essential teamwork skills such as communication, critical thinking, problem-solving, and creativity.

As they work together on these projects, they will also gain confidence in their ability to lead teams effectively—an invaluable asset no matter what industry they pursue after graduation.

Uncovering the Power of Creative Writing

Creative writing has become an increasingly powerful force in shaping our society. Creative writing has many uses, from preserving cultural heritage to promoting social change.

Preserving Cultural Heritage with Creative Writing

Creative writing has long been used to preserve and share cultural heritage stories. This is done through fictional stories or poetry that explore a particular culture or group’s history, values, and beliefs. By weaving these stories in an engaging way, writers can bring a culture’s history and traditions to life for readers worldwide. This helps bridge cultural gaps by providing insight into what makes each culture unique.

Promoting Social Change & Activism with Creative Writing

Creative writing can also be used for activism and social change. Writers can craft stories that help promote awareness about important issues such as poverty, race relations, gender equality, climate change, and more.

With the power of words, writers can inspire readers to take action on these issues and work towards creating positive change in their communities.

Through creative writing, writers can raise awareness about important topics while fostering empathy toward individuals who may be facing difficult or challenging situations.

Fostering Creativity & Innovation with Creative Writing

Finally, creative writing can foster creativity and innovation in various fields. For example, businesses can use creative copywriting techniques to create compelling content that captures the attention of customers or potential investors.

Aspiring entrepreneurs can use storytelling techniques when pitching their ideas or products to potential partners or investors to make their cases more persuasive and memorable.

By harnessing the power of words through creative writing techniques, businesses can create content that resonates with their target audience while inspiring them to take action on whatever message they’re trying to convey. It often aids the overall creative process.

Frequently Asked Questions

What are the benefits of creative writing.

Creative writing has many benefits, both for the writer and the reader. For the writer, it can be therapeutic, helping them to explore their emotions and better understand themselves. It can also be used as entertainment or communication, allowing them to share their ideas with the world. For the reader, creative writing can provide enjoyment, escapism, and insights into the human condition.

How can I improve my creative writing skills?

There are several ways you can improve your creative writing skills. Firstly, make sure you allow yourself time to write regularly. Use a writing prompt to inspire a short story. Secondly, read as much as you can; great writers are also great readers. Thirdly, experiment with different styles and genres to find one that suits you best. Fourthly, join a writers’ group, writing workshop, or creative writing program to get feedback from other writers. Finally, keep a journal to track your progress and reflect on your work as a creative writer.

What is the importance of imagery in creative writing?

Imagery is an important element of creative writing, as it helps to create a more vivid picture for the reader. By using sensory and descriptive language, writers can transport readers into their stories and help them relate to their characters or themes. Imagery can bring a scene alive with detail and evoke emotion by helping readers create strong visual images in their minds. Furthermore, imagery can help make stories more memorable by giving readers a deeper connection with the characters or setting.

What are the elements of creative writing?

The elements of creative writing include plot, character, dialogue, setting, theme, and point of view. The plot is the structure or main storyline, while the character is the personage involved in this story. Dialogue includes conversations between characters to give insight into their emotions and relationships. Setting refers to the place or time in which a story takes place, while theme explores deeper meanings behind a story’s narrative. Finally, point of view defines how readers experience a story through first-person or third-person omniscient narration.

What’s the difference between creative writing and other types of writing?

The main difference between creative writing and other types of writing is that it allows the writer to create their own story, characters, settings, and themes. Creative writing also encourages writers to be inventive with their style and use descriptive language to evoke emotion or bring stories alive in readers’ minds. Other academic or technical writing types typically involve more research-based information and are usually more objective in their presentation. Additionally, most forms of non-creative writing will have stricter rules regarding grammar, structure, and syntax.

What is the golden rule of creative writing?

The golden rule of creative writing is to show, not tell. It’s the core creative writing skill. When it comes to creative writing, it’s essential to use descriptive language that immerses readers in the story and allows them to experience the events through their emotions and imaginations. This can be done through metaphors, similes, sensory language, and vivid imagery.

How important is creativity in writing?

Creativity is essential in writing as it allows writers to craft a unique story and evoke emotion from the reader. Creativity can bring stories alive with fresh perspectives and exciting plot lines while creating an escape for readers and giving them more profound insights into the human condition. Writers who combine creativity with technical aspects such as grammar, structure, language usage, and flow will create pieces that capture their audience’s attention and provide an enjoyable reading experience.

Why is creative writing so important?

A healthy society has a healthy relationship to creativity. People in a dysfunctional society are afraid to make art, or they’re dismissive of it.

Distraction, fear and fatigue often come up in times of transition. These are normal responses to the hard work of transformation.

Old cultural stories are crumbling, and this is an excellent opportunity for healing and creation. Words are powerful magic. Stories can transport us. Writers make culture and show us how to experience transformation.

Our artistic practice helps us navigate confusion on our way to understanding. It helps us build resilience. This is why creative writing is so important.

I want us to be nurturing healthy relationships with our writing craft and the magic of story. And our relationship to creativity might need extra care and attention right now.

I want us to write whatever we want beautifully, imperfectly, in the face of fear, without permission from the status quo.

This is what I believe:

✯ Art is important and life-giving.

✯ Creative writing is a contemplative art that requires attention, curiosity and love.

✯ When we have a deep, reliable connection to our spirit, we make art that can heal, delight, and lead us.

✯ We connect to our creative spirit with more pleasure and ease when we focus together.

Everything we do at SSWS revolves around these principles.

Our core values turn into inspired collective action in our online community for writers, Centered .

Join us for community, an active discussion forum, feedback on your writing, monthly calls with me, office hours with our Writers & Creatives in Residence, and much more.

Here's to more connection, more creative spirit, and more love.

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Why You Should Study Writing

by Melissa Donovan | Jul 6, 2023 | Better Writing | 6 comments

Study writing to master the craft.

Stephen King said, “If you want to be a writer, you must do two things above all others: read a lot and write a lot.”

He’s right. These are the only two things you absolutely must do in order to be a writer. But they aren’t the only things you can or should do. Plenty of other activities will benefit your writing. Foremost among these is studying the craft.

I know a lot of people shift uncomfortably in their chairs when they see the word study . If you’re in school, the last thing you need is more homework. And if you’re done with school, there’s a good chance you’re not interested in reliving the experience. Besides, writing is supposed to be fun, right?

Well, yes. Writing is fun. But it’s not always fun. There are some parts of the process that aren’t fun at all. And studying is not always tedious. When you study something that you’re interested in (like writing), it’s a lot more engaging and a lot less laborious.

Reasons to Study Writing

Here are some of the benefits you’ll reap when you study writing:

Obviously, studying anything, including writing, is a way to acquire knowledge. The more you study, the more you’ll know. If you want to be good at writing, you’ll need to explore the craft in greater depth.
When you study writing, you also gain practical experience because studies in writing include exercises that give you concrete practice at the craft.
Studying also helps you advance faster than learning strictly through hands-on experience.
Through the course of your studies, you’ll do a lot of reading, which, as Stephen King said, is essential to becoming a writer.
Writing requires a lot of different skills. You acquired the basic skills during your formative years. You’ll acquire more by reading and writing. When you study writing, you’ll expand your skills even more.
You will learn things you can’t (or don’t) learn any other way. For example, through study you could come across some writing technique or literary device that you’ve never encountered through reading or writing, and it could be just the thing you need for some project you’re working on.
Learning new things is good for your cognitive health. The human brain needs a variety of stimulation, and acquiring new knowledge is essential for a good, strong mind. And of course, a good strong mind will ensure that your writing meets its full potential.

How to Study Writing

The most formal way to study writing is through an accredited school, such as a university or a community college. But that’s not the only way to study the craft. Here are some ways to study writing inside and outside of academia:

Take a class at your local university or community college. If you can’t find one nearby, look into online classes offered by these institutions.
Expand your search for online courses. For example, MasterClass offers writing courses by luminaries such as Neil Gaiman, Margaret Atwood, R.L. Stine, and Judy Blume as well as Dan Brown and James Patterson. Shonda Rhimes and Aaron Sorkin offer courses on writing for screen and stage.
Get books on the craft. I was lucky to study creative writing in college. Since then, books on the craft have been my favorite way to continue learning. They allow you to study broadly or zoom in on particular areas of focus, such as characterization or plotting.
Pick up college textbooks and use them as a guide to create your own study plan. Check out the English department on an accredited university’s website and see if you can find a course syllabus for creative writing, fiction writing, or poetry. Use the syllabus to create your own self-paced study.
Hire a writing coach. This is a great way to learn through study and practical application. A good writing coach will be able to identify your writing weaknesses and guide you through the process of learning how to eliminate them.
Join a writing group. While this is a less formal method of study, you will inevitably pool and share your knowledge, as a group.
Take a workshop. Workshops focus more on the practice of writing and using feedback to improve your writing, but you’ll learn a lot of technique and pick up other knowledge through the process. For example, I first heard the word juxtaposition in a workshop. I felt silly because I didn’t know what it meant, so I looked it up after the class and I remember it to this day.
Subscribe to journals, magazines, and blogs. Lots of these publications offer articles that import important knowledge about the craft of writing. Make sure you’re getting information from a credible source when you’re getting it off the Internet.

Some of us love learning, so studying writing comes easily, and it’s enjoyable. If study doesn’t sound like a fun activity, consider the benefits and the ease with which you can engage in a little study each week to expand your knowledge and skills.

How do you study writing? Have you taken classes? Do you have a collection of books on the craft? What is your favorite learning method? Share your thoughts by leaving a comment, and keep writing!

I agree. Studying writing is the best way to improve. I’m in the middle of reading James Scott Bell’s The Art of War for Writers. He has some very specific advice about getting a notebook and using it as the basis for your study as you read other authors’ work. He suggests we take notes on beautiful images we find as we read, passages of language we find unique or intriguing or inspiring, ways an author handles point of view — anything that jumps out at us as something we would like to try. I highly recommend his book for the wealth of tips he has on starting and pursuing a writing career through what he calls “A Writing Improvement Program.”

Hi Susan. Thanks for this recommendation. I agree — studying writing is one of the best ways to gain skills. Keep writing!

A valuable post. I know, that by reading I’ve learned a lot. I now read in a different way. Not just absorbing the plot and falling in love with the characters, but noticing the techniques other writers use. I am also a member of a critique group and have learned a lot there, too. As yet, I’ve not taken a formal class. Reading books such as Stephen King’s On Writing is a valuable way to learn your craft, and I found a Brandon Sanderson online workshop. Other authors are so helpful.

Hi Vivienne. I agree with everything you’ve said. It’s important to examine other writers’ techniques, and critique groups are immensely helpful. Brandon Sanderson’s online classes are priceless!

Any other art and all sport requires practice and skill building Writing shouldn’t be treated any differently.

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8 Good Reasons to Study Creative Writing

Whether or not people are aware, writing is a huge part of everyday life and can be found in almost every facet of communication. Reading a book or poem is quite literally where words are creatively telling a story, but creative writing exists in film, theatre, television, social media, almost anywhere something is communicated. So if it’s so ubiquitous, why study it? The answer lies in the quality of what we read and what we listen to and watch. Anyone with basic levels of literacy can write, but only a few write well. The reason for this has as much to do with skill as it does with talent; and this is where a creative writing course is invaluable.

Here are 8 fundamental reasons why studying creative writing is an absolute necessity for anyone eager to improve their writing.

1. Enhancing Writing Skills

In order to enhance writing skills, the writer must push themselves out of their comfort zone and test their mettle. A tutor will task students to write a variety of different assignments and by experimenting with different genres, a writer will expose themself to an inner voice they may never have otherwise known existed. If you enjoy writing fiction, write a memoir. If you love poetry, write an article. Try a screenplay, a crime story, a blog! Whatever it is, make sure it’s new to you. It should at first feel a little clumsy and awkward, but with the guidance of a tutor, you will soon discover that you have perhaps a broader range of writing skills than you originally believed.

2. Encouraging Critical Thinking

Critical thinking is a skill that is taught and should not be mistaken for finding fault or simply comparing work. It is analysis and story dissection. In order for a writer to accurately evaluate a story structure or understand pace or character development, they first need informed guidance to understand how to approach such intelligent critique. These skills are invaluable, not just in writing, but in everyday problem-solving and decision-making.

3. Fostering a Sense of Community

There are those who want to write but are not at all comfortable with the solitary nature of the craft. However, writing does not need to be a solo endeavour. Creative writing courses offer a supportive community of like-minded individuals where students will share their work, receive feedback, and engage in constructive criticism. This is a vital part of your development as a writer and is a truly interactive experience.

4. Providing Access to Experienced Instructors

This is gold! One of the greatest assets of a creative writing course is the access to experienced and knowledgeable instructors. Professional writers can provide guidance, share industry insights, and offer invaluable feedback to help refine your writing.

5. Building a Writing Routine

As a writer, you will be dependent on self governance and self discipline. Again, these are skills that are taught and with a little practice, can indeed become a daily routine of life. The nature of a structured course will naturally encourage consistency and direction, helping writers develop a writing schedule. Writing is a job and involves commitment and continuous effort. A creative writing course can introduce this mindset to a budding writer, without them even realising it is happening.

6. Enhancing Emotional Intelligence

Through storytelling and character development, writers must learn to empathise and to look at the world from different perspectives. Characters can be fictional or nonfiction, fantastical or mundane but one thing they cannot be is the same as each other. In order to create stories and characters with depth and humanity, a writer must delve into areas unfamiliar to them. Characters cannot always have the same opinions, outlook and desires as the writer. This exploration will, almost by osmosis, enhance emotional intelligence and interpersonal skills.

7. Boosting Confidence

An enormous benefit of studying creative writing is the confidence a writer will earn as they progress through a course . Feedback from peers and from a tutor will help a writer to see where they can improve and where they are succeeding. It can be very difficult for a writer to critically analyse their own work, they are simply too close to it. This boosted self-esteem can extend beyond writing and can positively impact other areas of life.

8. Offering a Creative Outlet

A creative writing course provides a structured outlet for self-expression. Students can channel their thoughts, feelings, and ideas into their work and feel the freedom and encouragement to take some risks and to truly express themselves. Attending a course can provide a sense of catharsis and a great sense of personal fulfilment.

Whether you're looking to improve your writing skills, connect with a community of writers, or simply find a creative outlet, our creative writing course offers a wealth of benefits. Our tutors are professional writers with experience across numerous genres. If you have a story you want to tell but are not sure how to channel it, our courses are where you’ll find that path. Perhaps you are already a published author or a writer interested in broadening their skillset, then we have just the course for you. With experienced instructors, a supportive environment, and a focus on critical thinking and emotional intelligence, these courses provide a comprehensive experience that can significantly enhance both your writing and your personal development.

Enrol today and find your writing voice.

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Why the teaching of creative writing matters

Lecturer in Creative Writing, University of Bolton

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Simon Holloway lectures in Creative Writing at The University of Bolton

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For the last 30 years or so the rise of creative writing programmes in universities has been met with seemingly unending howls of derision from all quarters. Hanif Kureishi, novelist, screenwriter – and professor of creative writing at Kingston University – described them as a “waste of time”. But universities around the world beg to differ, as the increasing number of courses and students testify.

The recent Sunday Times league tables for universities ranked the quality of teaching in creative writing at The University of Bolton as the best in the country. The programme there also boasts the highest ranking in terms of student experience.

Given that I am the only full-time lecturer in creative writing at Bolton – and also led the programme for two of the three years the recent figures cover – I should be able easily to explain our success, and why our students rate our teaching so highly. I say “should”, because I’m not sure of the answer.

There are easy ways to get students to rate teaching highly. We can tailor the classes to their personal needs and wants, and give them all high marks. Or we can teach them at a lower level than we should so that they feel a greater sense of achievement. But at Bolton we do none of these. So what’s the secret?

The measure of a mark

How you actually go about judging the quality of teaching – particularly with a subject like creative writing – is tricky. There are the normal ways that universities use: peer-assessment, student feedback, the evaluation of staff by professionals who specialise in methods of teaching and learning and staff development programmes. And as Bolton is a teaching intensive, research informed university we do a lot of these things, and I think we do them very well.

But I wonder whether what is being measured or evaluated in these assessments is more the style of the teacher, rather than the content. Most assessors are experts in teaching methods and practices – and it’s unreasonable to expect them to have detailed knowledge of every subject.

As non-specialists they are able to measure the levels of student engagement, of academic challenge, of whether the “learning outcomes” which plague university teaching in creative writing are being met. And if you measure it this way, then it’s quite possible that detractors such as Kureishi are right.

A place for play

Except that the teaching of creative writing, when done well, is about more than the skills and craft and technique, important as these things are. And as the writer and lecturer Liam Murray Bell describes, writers must find and use a consistency of tone, style and voice.

It’s also about encouraging students to play, to move beyond their normal styles and subjects of writing, beyond their use of traditional structural, narrative and poetic forms – and to ask them to see what happens. In this sense university is a place for play . Teacher and game designer Eric Zimmerman has defined play as:

The free space of movement within a more rigid structure. Play exists both because of and also despite the more rigid structures of a system.

If students are not actively encouraged to play then we are simply encouraging them to remain as static as they were when they entered higher education – even if they are more adept at using “writerly” skills and techniques.

The secret of success

To me it seems there is no “secret” to good teaching. You do the basics, and you do them as well as you possibly can. You limit class numbers. You give student-writers the individual attention they crave. You make sure that your teachers are good writers and that your writers are good teachers, so that expertise can be shared effectively.

And you make students read widely. They should read the classics, I suppose, but they should also read the “non-classics” – what many academics see as trash fiction. And they should read their peers and contemporaries too.

Importantly, they should read things such as advertising billboards and street signs, the shapes of buildings, the colour of the pavement, the weather, the look in people’s faces. Writers need to breathe in so that they can breathe out their own individual reactions and responses. At Bolton we spend time reading and breathing, and that helps students find voices and interactions which can blend with the craft of writing to produce work which means something to them.

Very few students will earn a living as a writer. But writing is about more than that, and the ability to communicate effectively is a rare and precious thing. Good teaching should not be measured in the texts which students produce, then, but in the knowledge gained through the actions of writing – knowledge which lasts forever.

In the end, if students enjoy their studies, and believe that they’re gaining skills which are transferable in the workplace and will last them well beyond university, then perhaps that is what they see as ‘good teaching’. And perhaps too they’re the best ones to judge.

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How Creative Writing Can Increase Students’ Resilience

Many of my seventh-grade students do not arrive at school ready to learn. Their families often face financial hardship and live in cramped quarters, which makes it difficult to focus on homework. The responsibility for cooking and taking care of younger siblings while parents work often falls on these twelve year olds’ small shoulders. Domestic violence and abuse are also not uncommon.

To help traumatized students overcome their personal and academic challenges, one of our first jobs as teachers is to build a sense of community. We need to communicate that we care and that we welcome them into the classroom just as they are. One of the best ways I’ve found to connect with my students, while also nurturing their reading and writing skills, is through creative writing.

For the past three years, I’ve invited students in my English Language Development (ELD) classes to observe their thoughts, sit with their emotions, and offer themselves and each other compassion through writing and sharing about their struggles. Creating a safe, respectful environment in which students’ stories matter invites the disengaged, the hopeless, and the numb to open up. Students realize that nobody is perfect and nobody’s life is perfect. In this kind of classroom community, they can take the necessary risks in order to learn, and they become more resilient when they stumble.

Fostering a growth mindset

One of the ways students can boost their academic performance and develop resilience is by building a growth mindset. Carol Dweck, Stanford University professor of psychology and author of the book Mindset , explains that people with a growth mindset focus on learning from mistakes and welcoming challenges rather than thinking they’re doomed to be dumb or unskillful. A growth mindset goes hand in hand with self-compassion: recognizing that everyone struggles and treating ourselves with kindness when we trip up.

One exercise I find very useful is to have students write a story about a time when they persevered when faced with a challenge—in class, sports, or a relationship. Some of the themes students explore include finally solving math problems, learning how to defend themselves, or having difficult conversations with parents.

I primed the pump by telling my students about something I struggled with—feeling left behind in staff meetings as my colleagues clicked their way through various computer applications. I confided that PowerPoint and Google Slides—tools (one might assume) that any teacher worth a paperweight has mastered—still eluded me. By admitting my deficiency to my students, asking for their help, and choosing to see the opportunity to remedy it every day in the classroom, I aimed to level the playing field with them. They may have been reading three or four grade levels behind, but they could slap a PowerPoint presentation together in their sleep.

For students, sharing their own stories of bravery, resilience, and determination brings these qualities to the forefront of their minds and helps solidify the belief that underlies a growth mindset: I can improve and grow . We know from research in neuroplasticity that when students take baby steps to achieve a goal and take pride in their accomplishments, they change their brains, growing new neural networks and fortifying existing ones. Neurons in the brain release the feel-good chemical dopamine, which plays a major role in motivating behavior toward rewards.

After writing about a few different personal topics, students choose one they want to publish on the bulletin boards at the back of the classroom. They learn to include the juicy details of their stories (who, what, when, where, why, and how), and they get help from their peers, who ask follow-up questions to prompt them to include more information. This peer editing builds their resilience in more ways than one—they make connections with each other by learning about each other’s lives, and they feel empowered by lending a hand.

In my experience, students are motivated to do this assignment because it helps them feel that their personal stories and emotions truly matter, despite how their other academics are going. One student named Alejandro chose to reflect on basketball and the persistence and time it took him to learn:

Hoops By Alejandro Gonzalez Being good takes time. One time my sister took me to a park and I saw people playing basketball. I noticed how good they were and decided I wanted to be like them. Still I told my sister that basketball looked hard and that I thought I couldn’t do it. She said,“You could do it if you tried. You’ll get the hang of it.” My dad bought me a backboard and hoop to play with. I was really happy, but the ball wasn’t making it in. Every time I got home from school, I would go straight to the backyard to play. I did that almost every day until little by little I was getting the hang of it. I also played with my friends. Every day after lunch we would meet at the basketball court to have a game. … I learned that you need to be patient and to practice a lot to get the hang of things. With a little bit of practice, patience, and hard work, anything is possible.

Originally, Alejandro wasn’t sure why he was in school and often lacked the motivation to learn. But writing about something he was passionate about and recalling the steps that led to his success reminded him of the determination and perseverance he had demonstrated in the past, nurturing a positive view of himself. It gave him a renewed sense of investment in learning English and eventually helped him succeed in his ELD class, as well.

Maintaining a hopeful outlook

Another way to build resilience in the face of external challenges is to shore up our inner reserves of hope —and I’ve found that poetry can serve as inspiration for this.

For the writing portion of the lesson, I invite students to “get inside” poems by replicating the underlying structure and trying their hand at writing their own verses. I create poem templates, where students fill in relevant blanks with their own ideas.

One poem I like to share is “So Much Happiness” by Naomi Shihab Nye. Its lines “Even the fact that you once lived in a peaceful tree house / and now live over a quarry of noise and dust / cannot make you unhappy” remind us that, despite the unpleasant events that occur in our lives, it’s our choice whether to allow them to interfere with our happiness. The speaker, who “love[s] even the floor which needs to be swept, the soiled linens, and scratched records,” has a persistently sunny outlook.

It’s unrealistic for students who hear gunshots at night to be bubbling over with happiness the next morning. Still, the routine of the school day and the sense of community—jokes with friends, a shared bag of hot chips for breakfast, and a creative outlet—do bolster these kids. They have an unmistakable drive to keep going, a life force that may even burn brighter because they take nothing for granted—not even the breath in their bodies, life itself.

Itzayana was one of those students who, due to the adversity in her life, seemed too old for her years. She rarely smiled and started the school year with a defiant approach to me and school in general, cursing frequently in the classroom. Itzayana’s version of “So Much Happiness” hinted at some of the challenges I had suspected she had in her home life:

It is difficult to know what to do with so much happiness. Even the fact that you once heard your family laughing and now hear them yelling at each other cannot make you unhappy. Everything has a life of its own, it too could wake up filled with possibilities of tamales and horchata and love even scrubbing the floor, washing dishes, and cleaning your room. Since there is no place large enough to contain so much happiness, help people in need, help your family, and take care of yourself. —Itzayana C.

Her ending lines, “Since there is no place large enough to contain so much happiness, / help people in need, help your family, and take care of yourself,” showed her growing awareness of the need for self-care as she continued to support her family and others around her. This is a clear sign of her developing resilience.

Poetry is packed with emotion, and writing their own poems allows students to grapple with their own often-turbulent inner lives. One student commented on the process, saying, “By writing poems, I’ve learned to be calm and patient, especially when I get mad about something dumb.” Another student showed pride in having her writing published; she reflected, “I feel good because other kids can use it for calming down when they’re angry.”

To ease students into the creative process, sometimes we also write poems together as a class. We brainstorm lines to include, inviting the silly as well as the poignant and creating something that represents our community.

Practicing kindness

Besides offering my students new ways of thinking about themselves, I also invite them to take kind actions toward themselves and others.

In the music video for “Give a Little Love” by Noah and the Whale, one young African American boy—who witnesses bullying at school and neglect in his neighborhood —decides to take positive action and whitewash a wall of graffiti. Throughout the video, people witness others’ random acts of kindness, and then go on to do their own bit.

“My love is my whole being / And I’ve shared what I could,” the lyrics say—a reminder that our actions speak louder than our words and do have an incredible impact. The final refrain in the song—“Well if you are (what you love) / And you do (what you love) /...What you share with the world is what it keeps of you”—urges the students to contribute in a positive way to the classroom, the school campus, and their larger community.

After watching the video, I ask students to reflect upon what kind of community they would like to be part of and what makes them feel safe at school. They write their answers—for example, not being laughed at by their peers and being listened to—on Post-it notes. These notes are used to create classroom rules. This activity sends a message early on that we are co-creating our communal experience together. Students also write their own versions of the lyrics, reflecting on different things you can give and receive—like kindness, peace, love, and ice cream.

Reaping the benefits

To see how creative writing impacts students, I invite them to rate their resilience through a self-compassion survey at the start of the school year and again in the spring. Last year, two-thirds of students surveyed increased in self-compassion; Alejandro grew his self-compassion by 20 percent. The program seems to work at developing their reading and writing skills, as well: At the middle of the school year, 40 percent of my students moved up to the next level of ELD, compared to 20 percent the previous year.

As a teacher, my goal is to meet students where they’re at and learn about their whole lives. Through creative writing activities, we create a community of compassionate and expressive learners who bear witness to the impact of trauma in each others’ experiences and together build resilience.

As a symbol of community and strength, I had a poster in my classroom of a boat at sea with hundreds of refugees standing shoulder to shoulder looking skyward. It’s a hauntingly beautiful image of our ability to risk it all for a better life, as many of my ELD students do. Recognizing our common humanity and being able to share about our struggles not only leads to some beautiful writing, but also some brave hearts.

About the Author

Laura Bean, M.F.A. , executive director of Mindful Literacy, consults with school communities to implement mindfulness and creative writing programs. She has an M.F.A. in Creative Writing and presented a mindful writing workshop at Bridging the Hearts and Minds of Youth Conference in San Diego in 2016.

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This Is Your Brain on Writing

By Carl Zimmer

June 20, 2014

A novelist scrawling away in a notebook in seclusion may not seem to have much in common with an NBA player doing a reverse layup on a basketball court before a screaming crowd. But if you could peer inside their heads, you might see some striking similarities in how their brains were churning.

That’s one of the implications of new research on the neuroscience of creative writing. For the first time, neuroscientists have used fMRI scanners to track the brain activity of both experienced and novice writers as they sat down — or, in this case, lay down — to turn out a piece of fiction.

The researchers, led by Martin Lotze of the University of Greifswald in Germany, observed a broad network of regions in the brain working together as people produced their stories. But there were notable differences between the two groups of subjects. The inner workings of the professionally trained writers in the bunch, the scientists argue, showed some similarities to people who are skilled at other complex actions, like music or sports.

The research is drawing strong reactions. Some experts praise it as an important advance in understanding writing and creativity, while others criticize the research as too crude to reveal anything meaningful about the mysteries of literature or inspiration.

Dr. Lotze has long been intrigued by artistic expression. In previous studies, he has observed the brains of piano players and opera singers, using fMRI scanners to pinpoint regions that become unusually active in the brain.

Needless to say, that can be challenging when a subject is singing an aria. Scanners are a lot like 19th-century cameras: They can take very sharp pictures, if their subject remains still. To get accurate data, Dr. Lotze has developed software that can take into account fluctuations caused by breathing or head movements.

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The benefits of creative writing

As you learn to clarify your thoughts and emotions more efficiently and accurately, through creative writing, you will communicate more effectively; a skill that’s exceedingly important in all areas of life.

Practising creative writing is about a lot more than just improving your grammar, spelling and vocabulary; it will allow you to develop your own unique voice and share your perspective without limitations, expressing how you feel about the worlds inside and outside of your head. When you engage in creative writing you’re stimulating your imagination and thinking outside the box, which teaches you how to think more innovatively and push boundaries. Both are valuable skills.

Creating a pretend universe will often mean assembling personalities, emotions, and places that might be totally alien to your own life experiences. This is an effective way to build on your capacity to feel empathy and understanding for people who may have had very different life experiences to your own. Your perspectives and philosophies can be mirrored or explored by your characters or their setting. With practise you’ll find yourself becoming more comfortable in asserting your opinions and values in real life.

Expressive writing can bring a range of mental, emotional, and physical health benefits.

If you engage with creative writing when you’re dealing with difficult emotions, it can help you explore why you’re feeling what you’re feeling, allowing a direct insight to your mindset. It’s an opportunity to work through whatever discomfort we’re experiencing so we can get back to whatever we want to achieve today; a healthy way to alleviate the negative thoughts and emotions we experience on a day-to-day basis.

Of course, creative writing exercises can also expand your vocabulary and provide a better understanding of the mechanics of the written word. You’ll learn to distinguish when grammar works and when it doesn’t. With practise, your writing will flow better for the reader.

According to clinical psychologist Karen A.Baikie and psychiatrist Kay Wilhelm, writing creatively about traumatic, stressful or emotional events has been found to improve both physical and psychological health. In a clinical trial, participants who wrote about difficult life events for 20 minutes, on a handful of occasions, had significantly better physical and psychological outcomes compared to those who wrote about neutral topics. Baikie and Wilhelm concluded that expressive writing has real potential as a therapeutic tool for survivors of trauma and in mental health treatment settings.

By Grant J Everett, Panorama magazine

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Study Creative Writing, why & how to study

A degree in creative writing will develop your imagination and storytelling skills to help you find your voice..

What’s Creative Writing?

What creative writing degrees can you study, what do you need to get onto a creative writing degree, what topics does a creative writing degree cover, how will you be assessed, why study creative writing, are scholarships and bursaries available to students studying a creative writing degree, what are the postgraduate opportunities, similar subjects to creative writing, have any questions, looking for clearing advice.

The Clearing concierge has the answers

Creative Writing degrees cover all aspects of writing from fiction to non-fiction and poetry to scriptwriting. You’ll develop a portfolio of work and explore the many career options available to you.

Take a look at the university league table for Creative Writing.

Undergraduate degrees in Creative Writing can be studied as a single subject or combined with other areas like literature, film and drama. Some examples include:

Creative Writing BA

Develop your creative and critical writing skills and expand your range and capabilities as a writer. Topics typically cover approaches to literature and cultural history, critical thinking and literary theory among others.

Search for Creative Writing courses.

American Literature with Creative Writing BA

If you are a lover of American literature, indulge your passion by developing your creative practice, knowledge of American literature, and your industry links. This option often includes a year studying abroad.

Explore American Literature with Creative Writing Courses.

English with Creative Writing BA

A programme that allows students to focus on creating their own texts, alongside studying the work of other writers.

Look for English with Creative Writing courses.

Journalism and Creative Writing BA

A Journalism with Creative Writing BA will teach you core journalistic techniques and help you develop writing skills to deliver effective content across multiple platforms, while also encouraging your creative side.

Discover Journalism and Creative Writing courses.

Theatre: Writing, Directing and Performance BA

Develop keen critical analysis skills alongside your practical work in acting, directing and playwriting, and explore a broad range of plays and productions covering theatre’s many pasts and presents.

Find Theatre: Writing, Directing and Performance courses.

Other options

Options may include an integrated foundation year or placement in the UK or abroad.

Find a Creative Writing undergraduate course
Types of undergraduate degrees

Must have

Entry requirements for a Creative Writing degree at a university range from 80–160 UCAS points. This could include:

A Levels: AAA–CCE
BTECs: DDD–MMP (may also require an English Literature A Level)
Scottish Highers: AAAAB–BBBB (Advanced Highers: AAB–ABB)
International Baccalaureate: 38–26
Universities usually ask for English or English literature at A Level (or equivalent) and a sample of your own writing

Good to have

If you’re doing a combined degree, an A Level of equivalent in the additional subject
Evidence of extensive reading and your influences
Evidence of your love of writing e.g., involvement with writing group, entering writing competition, going to author talks and literary festivals
Relevant work experience or volunteering e.g., supporting communications for a charity, office work at a publisher, shadowing a copywriter
Portfolio of work, e.g., your own blog or contributing articles to magazines
Entry requirements
About UCAS points
Alternatives to A Levels

Typical modules for courses in this subject include:

Adventures in literature and the history of ideas
Composition and creative writing
Creative writing drama
Epic into novel
Future directions
Imagine this: prompts for creative writing
Writing for publication
Writing for short form media
Writing poetry and fiction

Assessments are mainly coursework based, and may include the following methods:

Presentation
Reflective writing
A dissertation is usually a final year option

Career-specific skills

Skills in creative writing to the standards required by the industry – whether publishing, film and TV, or for web content online
Editing, redrafting and proofreading

Transferable skills

Communication
Creative thinking and analysis
Digital skills
Negotiation
Prioritising and time management
Problem solving
Research and analysis
Self-discipline

Professional accreditation

While there are no general professional accreditations for creative writing degrees, there may be some associated with it, for example, the National Council for the Training of Journalists (NCTJ).

Professional organisations

There are many different professional organisations relating to the different genres of creative writing, here are some places to start:

Publishers Association
National Centre for Writing
Society of Authors
The Writer’s Guild of Great Britain

The course appealed to me because of the course structure and syllabus. It is one of the only ones offering creative writing, English literature, and a dedicated publishing module. On a personal level, the lecturers have constantly pushed me to take more risks with my writing, to experiment and have fun with language and structure. Daniel, London Met

Read more about Daniel's story
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Some universities offer students an arts scholarship, bursary or grant. It’s worth seeing if you are eligible, how to apply and what it covers e.g., materials, tuition fees or living costs.

What do Creative Writing graduates earn?

Entry-level salaries start from around £16,700–£22,000 with many areas to go into. For example, an editorial assistant could earn between £18,000–£23,000, increasing to an average of £37,000 for a managing editor and make anything between £45,000–£65,000 as an editorial director.

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What jobs can you get as a Creative Writing graduate?

There are lots of possible career paths, some obvious, some less so including:

Brand consultant
Digital marketing executive
Editorial assistant
English teacher
Games writer
Press officer
Scriptwriter
Social media manager
Social worker
Travel writer
Web content manager
Writer in residence in prisons

Examples of postgraduate courses include:

Creative Writing PG/Dip/MA/MSt/MSc/MLitt/PhD
Crime and Thriller Writing MSt
Comedy Studies PhD
English Literary Studies with Creative Writing MA
Playwriting & Screenwriting MFA/MLitt
Find postgraduate courses for Creative Writing
Types of postgraduate degrees

If you enjoy a good story, you might also consider:

Drama, Dance & Cinematics

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Why Practicing Creative Writing Increases Writing Skill across Genres

Practicing creative writing had an incredible impact on a group of seventh-grade students’ writing abilities and dispositions. Creative writing could do the same for you.

What is the secret to helping kids improve their writing skills? How can teachers help students become more interested in writing? Motivating students to write at high levels can be hard, and even professional writers can feel stuck or uninterested at times. One way to unlock success in and passion for writing may be to do creative writing exercises.

THE RESEARCH

In the 2015 study “ Effects of Creative Writing Activities on Students’ Achievement in Writing, Writing Dispositions and Attitude to English ,” Sukran Tok and Anil Kandemir tested the power of creative writing. They began by giving thirty-one seventh-grade students a preliminary writing activity in which each student wrote briefly about the life of someone they knew well. Tok and Kandemir scored the students’ writing based on its content, organization, language use, and mechanics. The students also completed a Likert scale questionnaire to measure their attitudes and dispositions toward writing.

Tok and Kandemir then had the students complete four creative writing exercises. After completing all the exercises, the students repeated the first writing activity. Tok and Kandemir scored the writing, and the students completed the questionnaire again. The researchers found that the students’ second writing scores were significantly higher than their first. The students’ scores on the writing disposition questionnaire had also significantly improved. The average scores for both the writing score and the writing disposition test were ten points higher.

Although the study only lasted four weeks, the creative writing activities seemed to have a profound effect on increasing the students’ skills and attitudes toward writing. Tok and Kandemir explained, “Based on these results, it can be suggested that creative writing activities can be used in 7th grade English course[s] to increase students’ achievement in writing skill and [lead] them to write more.”

“Based on these results, it can be suggested that creative writing activities can be used in 7th grade English course[s] to increase students’ achievement in writing skill and lead them to write more.” —Sukran Tok and Anil Kandemir (2015)

THE IMPLICATIONS

These results are especially meaningful for educators who are interested in helping students improve their writing skills and increase their interest in writing. Although the sample size of the research is limited in scope to thirty-one students and the experimental design could have benefited from a control group, the results suggest that creative writing exercises could benefit writers who want to increase their passion for writing.

To learn more about the power of creative writing, read the full article:

Tok, Sukran, and Anil Kandemir. 2015. “Effects of Creative Writing Activities on Students’ Achievement in Writing, Writing Dispositions and Attitude to English.” Procedia — Social and Behavioral Sciences 174: 1635–42. https://doi.org/10.1016/j.sbspro.2015.01.815 .

—Emma Freestone, Editing Research

FEATURE IMAGE BY JESWIN THOMAS

Find more research

Read Elizabeth Gallacher’s Editing Research article to learn more about creative writing: “ Diving into Creative Writing Technicalities .”

Read David McVey’s (2008) article to learn more about how creative writing relates to all types of writing: “Why All Writing Is Creative Writing.” Innovations in Education and Teaching International 45 (3). https://doi.org/10.1080/14703290802176204 .

The Cognitive Effort of Writing While Researching

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Why Fortnite Needs Editing Too

Simon Laraway

Interesting stuff! I’m curious what sorts of creative writing exercises the students did. What sorts of prompts can help students (and writers of all sorts) break out of their slumps and get more creative?

English and Creative Writing

The Franklin College Department of English and Creative Writing is committed to the careful study of the individual expression and cultural values found in English, American, and world literature.

The department is one of Franklin College’s most exciting intellectual communities. Our faculty of dedicated teacher-scholars share with students their expertise in, and enthusiasm for, literature from a variety of genres, periods, and cultures—works drawn from the traditional canon to the works of emerging artists, from Greek tragedy to graphic novels, from Shakespearean sonnets to postmodern poetry. Small class sizes mean professors get to know their students and can engage with them in intense debates and deep analyses of literary works that continue outside the classroom.

Our dedicated faculty of practicing writers and scholars guide students in small classes and workshops that cover a variety of genres, as well as provide students with frequent out-of-class opportunities to exercise and hone their craft. Creative writing students can expect a rigorous yet collegial environment that allows for engaged learning, collaboration and experimentation.

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Why English and Creative Writing?
Major Handouts & Course Catalog
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Why english and creative writing at franklin college.

Dynamic classroom experiences.

Our professors use a variety of approaches that focus on how language and literary forms recreate both individual experiences and the large, impersonal forces that shape cultures and historical periods. In so doing, we seek in our classes to understand the many varieties of the human condition. In addition to taking courses with our award-winning faculty, our creative writing students benefit from the creative writing program’s reading series, which brings talented poets, fiction writers, memoirists, and playwrights to teach and study with them each year.

Experiences beyond the classroom.

Not only do English and creative writing majors learn a great deal in the classroom, they also take part in activities related to the disciplines. Such activities regularly include working on the editorial board of the college literary journal, the Apogee (founded in 1961); attending performances and creative-writing readings; and participating in other events in and around Franklin, Indianapolis, Bloomington, Louisville, and elsewhere in the region.

Global engagement.

With opportunities to study abroad during entire semesters, during the college’s four-week Immersive Term, or over the summer, English majors have recently taken courses in England, France, Spain, Costa Rica, Germany, Uganda, Japan, and elsewhere.

Interdisciplinary commitment.

In keeping with the college’s strong interdisciplinary character, English and Creative Writing majors frequently choose to pursue a second major or a minor in disciplines such as elementary education , French , history , multimedia journalism , political science , philosophy , psychology , religious studies, or Spanish . Recent English courses have been cross-listed in theatre and the liberal arts program, and students may count an upper-level course in French or Spanish literature toward their English degree.

Connecting passion with work.

Our faculty advisers are committed to helping students find careers in fields that excite them. Recent graduates have used their English degrees to pursue rewarding careers in teaching, publishing, health care, marketing, business, the performing and creative arts, communications, technical writing, and non-profit management. Others have gone on to graduate programs in English, law, divinity, library science, and counseling.

Spark your imagination.

Program handouts.

English Major Handout
Creative Writing Major Handout

Courses of Study

Students who choose to study english and creative writing at franklin college can pursue two different majors — english and creative writing. both are also available as a minor. in addition, we offer an additional minor in professional writing..

Immerse yourself in literature, history and the human condition as a Franklin College English major.

Experiment with language and style, developing a unique voice.

Creative Writing

Carlson-stauffer visiting writers’ series.

The English and Creative Writing department is proud to sponsor the Carlson-Stauffer Visiting Writers’ Series, which brings nationally recognized authors to campus. All events are free and open to the public.

Series Background

The series is named for two beloved professors emerita, Kathy Carlson and Emily Stauffer, both of whom retired in spring 2015. Together, their combined service at Franklin College spanned close to 70 years. The series began in 2015 and has allowed the department to host dozens of writers from across the country. Writers hold a publicly open reading. Typically, they also interact with creative writing students at a meal, visit creative writing classes to conduct a masterclass in their genre, and/or offer feedback on students’ writing.

Participating Writers

Visiting writers have been poets, fiction writers, YA authors, writers of non-fiction, and multi-genre writers. Some notable names include:

Marcus Wicker, 2015
Maggie Messitt, 2016
Jamaal May, 2017
David Tomas Martinez, 2018
Terrance Hayes, 2019
Nafissa Thompson-Spires, 2019
Ross Gay, 2019
Adrian Matejka, 2020 (and 2023)
Brooke Lauren Davis (’15) — YA novelist and alumna
Samantha Fain (’20) — poet and alumna
Eugene Gloria, 2021
Dan Chaon, 2022
Saundra Mitchell, 2023
Angela Jackson-Brown, 2023
Matthew Minnicucci, 2023
Brittany Means, 2024
Monica McClure, 2024

This fall (2024), the department will welcome back Samantha Fain (’20) to celebrate the release of her latest poetry collection, Are You There .

On Nov. 28, 2023, the department welcomed poet Matthew Minicucci for his second visit in our series. Matthew read from his fourth poetry collection, Dual, which was released by Acre Books. The event was held at 7 p.m. Tuesday, Nov. 28, 2023 in the B.F. Hamilton Auditorium. A book signing followed the reading.

“I believe that you get a sense of belonging and that you matter. Personally, I enjoy the conversations with professors and other faculty members and getting to know them.”

Emmarae Arensdorff ’22

Express your creativity through apogee, our annual literary journal., apogee is franklin college’s student-run literary magazine that accepts previously unpublished work in poetry, fiction, creative nonfiction, drama, and visual art. apogee is an annual publication published in late spring. submissions are open during the summer and fall..

Questions about Apogee ? Contact our Faculty Advisor.

Learn more about English and Creative Writing at Franklin College

Our mission.

By honing a diverse set of reading and writing skills, the English and creative writing department’s majors and minors recognize the artistic achievements, insights, and possibilities inherent in literature to create their own meaningful work as they prepare for professional positions, graduate study, and civic engagement.

Student Learning Outcomes

Students in English and Creative Writing will be able to:

Read and communicate effectively through creative and expository writing.
Make arguments about texts using literary terms, techniques, history and movements.
Access, analyze and synthesize complex information, using diverse perspectives.
Solve unstructured problems individually as well as collaboratively.

Our Faculty

In addition to their commitment to the classroom, faculty in the English and creative writing department maintain active scholarly agendas, publishing their research and presenting at major national and international conferences on a wide variety of topics, including the intersections of narrative theory and gender theory; the limitations of humanity in Shakespeare’s Richard II ; modernist irony as a response to colonial exhibitions; flipped classroom pedagogy; landscape and medieval gender roles; feminist readings of global modernism; and deforestation in contemporary Anglophone Caribbean literature. In addition, our creative writing faculty have won awards and national attention for their work.

Requirements

Introductory courses provide students with an understanding of different creative genres, as well as the fundamentals of creative writing processes, literary citizenship and the contemporary literary landscape. Students learn to read like writers, engaging in literary analysis to appreciate the nuances of text construction. In later courses, students perform genre-specific studies, closely studying, deploying and sharpening particular writing techniques, and engaging in significant revision and experimentation as they hone their unique voices and join ongoing literary conversations.

As creative writers, we untangle texts and cultural contexts to discover new strategies for reading and writing, with students interrogating both the worlds of the texts they read and write, and their own world, understanding how texts communicate, shape and move all of us. Through guided practice, students gain confidence, empathy, and practical critical writing and thinking skills that allow them to make powerful contributions to the world.

Meet the talented professionals who will help guide you on your creative journey.

Emily Banks, MFA, Ph.D.

Katie Burpo, M.F.A.

Susan Crisafulli, Ph.D.

Richard Erable, Ph.D.

Anna James, Ph.D.

George Phillips, Ph.D.

Department of english and creative writing.

101 Branigin Blvd. Franklin, IN 46131 Johnson Center for Fine Arts

317.738.8271

Monday - Thursday, 8 a.m. to 5 p.m. Fridfay, 8 a.m. to 4 p.m.

College of Arts and Sciences

English and Linguistics

Welcome Prospective Students: English and Linguistics
Feature Stories
Requirements for the Majors in English and English: Creative Writing
Requirements for the English Literature Minor
Requirements for the Professional Writing Minor
Linguistics (Catalog Info)
Linguistics Minor
Special Major in Linguistics
Careers in Linguistics
Linguistics Speaker Series
Honors in ENLI
Sample Proposals for Individual Study
Current and Past Student Individual Studies
Ongoing Internship Opportunities
Current and Past Student Internships
ENLI Internship Stories
ENGL 399: Community Service Learning
Upcoming, New, and Special Topics Courses

Why Study English and English: Creative Writing?

Students may major in English , with the options of concentrating in literature or creative writing , or may minor in linguistics or literature .

Student Isobel Rissing in Combs Hall

What do the majors in English and English: Creative Writing do for students?

They provide the context for intellectual maturity and enhanced creativity.
They develop a sophisticated understanding of history, culture, and the human condition.
They prepare students for careers that require critical thinking, communication skills, and the capacity to respond to new challenges.

What opportunities do English and English: Creative Writing students have at UMW?

In addition to coursework studying English and English: Creative Writing, ENLI students have access to such opportunities as:

High-impact service learning credit in the community through ENGL 399,
Honors Studies,
Presentation experience through the annual Kemp Symposium,
Support for professional experiential learning in internships for credit,
Study abroad for credit,
Working with publication of a literary journal,
Intensive research experience and individualized learning in custom-designed individual studies,
Experience analyzing writing and providing writing feedback as a consultant in the UMW Writing Center ,
Class field trips to literary sites ,
Department visits by renowned scholars and writers through such various programs, such as the Flywheel Reading Series and the Grellet & Dorothy C. Simpson Program in Medieval Studies .

Students may also combine their studies in English and Linguistics with other majors and minors.

Around campus, students have opportunities to meet and work with other like-minded students on major-related activities, including

working with and publishing in the Aubade literary journal,
working with the publication process in and writing for the The Weekly Ringer campus newspaper , or
writing- and major-related student clubs , which provide leadership and organizational opportunities.

The department participates in and sponsors a variety of topical campus events, including Banned Books Week and the National Day on Writing .

What can graduates with a degree in English do that employers and graduate schools alike find impressive?

They can write and speak well.
They can think creatively and, in turn, actively create.
They can process complex ideas and notice patterns.
They can understand multiple perspectives.
They can generate questions and pursue their answers through research.
They can argue for a particular point of view and evaluate the relative merits of others.
They can respond to, refer to, recognize, and rely on a wide array of highly regarded thinkers and artists, a body of knowledge that has organized, guided, and inspired human behavior, through narrative, theory, and critique.

UMW graduates have gone on to a variety of different placements with employers and graduate schools .

ENLI Resources

Virtual Visit!
Sample First-Year Schedules: English and English: Creative Writing
For More Information: Department Chair Contact Information
UMW Virtual Visits
UMW Admissions
Transfer to UMW
Flywheel Reading Series
Kemp Symposium
Grellet & Dorothy C. Simpson Program in Medieval Studies
Scholarships and Prizes
Advanced Studies in England
Career Services and You
Internship Experience
UMW English and Linguistics Alumni Career Titles
Asking Professors for Recommendations and/or References
Translate ENGL Skills to the Job Market
Preparing for a Career in Teaching in Schools and Beyond
Graduate School Placements
Give Back to ENLI

What is Creative Research?

What is "creative" or "artistic" research how is it defined and evaluated how is it different from other kinds of research who participates and in what ways - and how are its impacts understood across various fields of inquiry.

After more than two decades of investigation, there is no singular definition of “creative research,” no prescribed or prevailing methodology for yielding practice-based research outcomes, and no universally applied or accepted methodology for assessing such outcomes. Nor do we think there should be.

photo from *this is not a drill* exhibit

We can all agree that any type of serious, thoughtful creative production is vital

But institutions need rubrics against which to assess outcomes. So, with the help of the Faculty Research Working Group, we have developed a working definition of creative research which centers inquiry while remaining as broad as possible:

Creative research is creative production that produces new knowledge through an interrogation/disruption of form vs. creative production that refines existing knowledge through an adaptation of convention. It is often characterized by innovation, sustained collaboration and inter/trans-disciplinary or hybrid praxis, challenging conventional rubrics of evaluation and assessment within traditional academic environments.

Image from The Fire Bird by Fernando Gregório

This is where Tisch can lead

Artists are natural adapters and translators in the work of interpretation and meaning-making, so we are uniquely qualified to create NEW research paradigms along with appropriate and rigorous methods of assessment. At the same time, because of Tisch's unique position as a professional arts-training school within an R1 university, any consideration of "artistic" or "creative research" always references the rigorous standards of the traditional scholarship also produced here.

The long-term challenge is two-fold

Over the long-term, Tisch will continue to refine its evaluative processes that reward innovation, collaboration, inter/trans-disciplinary and hybrid praxis. At the same time, we must continue to incentivize faculty and student work that is visionary and transcends the obstacles of convention.

As the research nexus for Tisch, our responsibility is to support the Tisch community as it embraces these challenges and continues to educate the next generation of global arts citizens.

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BMJ Journals

Rebecca Payne 1 ,
Aileen Clarke 1 ,
Nadia Swann 1 ,
Jackie van Dael 1 ,
Natassia Brenman 1 ,
Rebecca Rosen 2 ,
Adam Mackridge 3 ,
Lucy Moore 1 ,
Asli Kalin 1 ,
Emma Ladds 1 ,
Nina Hemmings 2 ,
Sarah Rybczynska-Bunt 4 ,
Stuart Faulkner 1 ,
Isabel Hanson 1 ,
Sophie Spitters 5 ,
http://orcid.org/0000-0002-7758-8493 Sietse Wieringa 1 , 6 ,
Francesca H Dakin 1 ,
Sara E Shaw 1 ,
Joseph Wherton 1 ,
Richard Byng 4 ,
Laiba Husain 1 ,
http://orcid.org/0000-0003-2369-8088 Trisha Greenhalgh 1
1 Nuffield Department of Primary Care Health Sciences , University of Oxford , Oxford , UK
2 Nuffield Trust , London , UK
3 Betsi Cadwaladr University Health Board , Bangor , UK
4 Peninsula Schools of Medicine and Dentistry , University of Plymouth , Plymouth , UK
5 Wolfson Institute of Population Health , Queen Mary University of London , London , UK
6 Sustainable Health Unit , University of Oslo , Oslo , Norway
Correspondence to Professor Trisha Greenhalgh; trish.greenhalgh{at}phc.ox.ac.uk

Background Triage and clinical consultations increasingly occur remotely. We aimed to learn why safety incidents occur in remote encounters and how to prevent them.

Setting and sample UK primary care. 95 safety incidents (complaints, settled indemnity claims and reports) involving remote interactions. Separately, 12 general practices followed 2021–2023.

Methods Multimethod qualitative study. We explored causes of real safety incidents retrospectively (‘Safety I’ analysis). In a prospective longitudinal study, we used interviews and ethnographic observation to produce individual, organisational and system-level explanations for why safety and near-miss incidents (rarely) occurred and why they did not occur more often (‘Safety II’ analysis). Data were analysed thematically. An interpretive synthesis of why safety incidents occur, and why they do not occur more often, was refined following member checking with safety experts and lived experience experts.

Results Safety incidents were characterised by inappropriate modality, poor rapport building, inadequate information gathering, limited clinical assessment, inappropriate pathway (eg, wrong algorithm) and inadequate attention to social circumstances. These resulted in missed, inaccurate or delayed diagnoses, underestimation of severity or urgency, delayed referral, incorrect or delayed treatment, poor safety netting and inadequate follow-up. Patients with complex pre-existing conditions, cardiac or abdominal emergencies, vague or generalised symptoms, safeguarding issues, failure to respond to previous treatment or difficulty communicating seemed especially vulnerable. General practices were facing resource constraints, understaffing and high demand. Triage and care pathways were complex, hard to navigate and involved multiple staff. In this context, patient safety often depended on individual staff taking initiative, speaking up or personalising solutions.

Conclusion While safety incidents are extremely rare in remote primary care, deaths and serious harms have resulted. We offer suggestions for patient, staff and system-level mitigations.

Primary care
Diagnostic errors
Safety culture
Qualitative research
Prehospital care

Data availability statement

Data are available upon reasonable request. Details of real safety incidents are not available for patient confidentiality reasons. Requests for data on other aspects of the study from other researchers will be considered.

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/ .

https://doi.org/10.1136/bmjqs-2023-016674

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WHAT IS ALREADY KNOWN ON THIS TOPIC

Safety incidents are extremely rare in primary care but they do happen. Concerns have been raised about the safety of remote triage and remote consultations.

WHAT THIS STUDY ADDS

Rare safety incidents (involving death or serious harm) in remote encounters can be traced back to various clinical, communicative, technical and logistical causes. Telephone and video encounters in general practice are occurring in a high-risk (extremely busy and sometimes understaffed) context in which remote workflows may not be optimised. Front-line staff use creativity and judgement to help make care safer.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY

As remote modalities become mainstreamed in primary care, staff should be trained in the upstream causes of safety incidents and how they can be mitigated. The subtle and creative ways in which front-line staff already contribute to safety culture should be recognised and supported.

Introduction

In early 2020, remote triage and remote consultations (together, ‘remote encounters’), in which the patient is in a different physical location from the clinician or support staff member, were rapidly expanded as a safety measure in many countries because they eliminated the risk of transmitting COVID-19. 1–4 But by mid-2021, remote encounters had begun to be depicted as potentially unsafe because they had come to be associated with stories of patient harm, including avoidable deaths and missed cancers. 5–8

Providing triage and clinical care remotely is sometimes depicted as a partial solution to the system pressures facing primary healthcare in many countries, 9–11 including rising levels of need or demand, the ongoing impact of the COVID-19 pandemic and workforce challenges (especially short-term or longer-term understaffing). In this context, remote encounters may be an important component of a mixed-modality health service when used appropriately alongside in-person contacts. 12 13 But this begs the question of what ‘appropriate’ and ‘safe’ use of remote modalities in a primary care context is. Safety incidents (defined as ‘any unintended or unexpected incident which could have, or did, lead to harm for one or more patients receiving healthcare 14 ’) are extremely rare in primary healthcare consultations generally, 15 16 in-hours general practice telephone triage 17 and out-of-hours primary care. 18 But the recent widespread expansion of remote triage and remote consulting in primary care means that a wider range of patients and conditions are managed remotely, making it imperative to re-examine where the risks lie.

Theoretical approaches to safety in healthcare fall broadly into two traditions. 19 ‘Safety I’ studies focus on what went wrong. Incident reports are analysed to identify ‘root causes’ and ‘safety gaps’, and recommendations are made to reduce the chance that further similar incidents will happen in the future. 20 Such studies, undertaken in isolation, tend to lead to a tightening of rules, procedures and protocols. ‘Safety II’ studies focus on why, most of the time, things do not go wrong. Ethnography and other qualitative methods are employed to study how humans respond creatively to unique and unforeseen situations, thereby preventing safety incidents most of the time. 19 Such studies tend to show that actions which achieve safety are highly context specific, may entail judiciously breaking the rules and require human qualities such as courage, initiative and adaptability. 21 Few previous studies have combined both approaches.

In this study, we aimed to use Safety I methods to learn why safety incidents occur (although rarely) in remote primary care encounters and also apply Safety II methods to examine the kinds of creative actions taken by front-line staff that contribute to a safety culture and thereby prevent such incidents.

Study design and origins

Multimethod qualitative study across UK, including incident analysis, longitudinal ethnography and national stakeholder interviews.

The idea for this safety study began during a longitudinal ethnographic study of 12 general practices across England, Scotland and Wales as they introduced (and, in some cases, subsequently withdrew) various remote and digital modalities. Practices were selected for maximum diversity in geographical location, population served and digital maturity and followed from mid-2021 to end 2023 using staff and patient interviews and in-person ethnographic visits. The study protocol, 22 baseline findings 23 and a training needs analysis 24 have been published. To provide context for our ethnography, we interviewed a sample of national stakeholders in remote and digital primary care, including out-of-hours providers running telephone-led services, and held four online multistakeholder workshops, one of which was on the theme of safety, for policymakers, clinicians, patients and other parties. Early data from this detailed qualitative work revealed staff and patient concerns about the safety of remote encounters but no actual examples of harm.

To explore the safety theme further, we decided to take a dual approach. First, following Safety I methodology for the study of rare harms, 20 we set out to identify and analyse a sample of safety incidents involving remote encounters. These were sourced from arm’s-length bodies (NHS England, NHS Resolution, Healthcare Safety Investigation Branch) and providers of healthcare at scale (health boards, integrated care systems and telephone advice services), since our own small sample had not identified any of these rare occurrences. Second, we extended our longitudinal ethnographic design to more explicitly incorporate Safety II methodology, 19 allowing us to examine safety culture and safety practices in our 12 participating general practices, especially the adaptive work done by staff to avert potential safety incidents.

Data sources and management

Table 1 summarises the data sources.

View inline

Summary of data sources

The Safety I dataset (rows 2-5) consisted of 95 specific incident reports, including complaints submitted to the main arm’s-length NHS body in England, NHS England, between 2020 and 2023 (n=69), closed indemnity claims that had been submitted to a national indemnity body, NHS Resolution, between 2015 and 2023 (n=16), reports from an urgent care telephone service in Wales (NHS 111 Wales) between 2020 and 2023 (n=6) and a report on an investigation of telephone advice during the COVID-19 crisis between 2020 and 2022 7 (n=4). These 95 incidents were organised using Microsoft Excel spreadsheets.

The Safety II dataset (rows 6-10) consisted of extracts from fieldnotes, workshop transcripts and interviews collected over 2 years, stored and coded on NVivo qualitative software. These were identified by searching for text words and codes (e.g. ‘risk’, ‘safety’, ‘incident’) and by asking researchers-in-residence, who were closely familiar with practices, to highlight safety incidents involving harm and examples of safety-conscious work practices. This dataset included over 100 formal interviews and numerous on-the-job interviews with practice staff, plus interviews with a sample of 10 GP (general practitioner) trainers and 10 GP trainees (penultimate row of table 1 ) and with six clinical safety experts identified through purposive sampling from government, arm’s-length bodies and health boards (bottom row of table 1 ).

Data analysis

We analysed incident reports, interview data and ethnographic fieldnotes using thematic analysis as described by Braun and Clarke. 25 These authors define a theme as an important, broad pattern in a set of qualitative data, which can (where necessary) be further refined using coding.

Themes in the incident dataset were identified by five steps. First, two researchers (both medically qualified) read each source repeatedly to gain familiarity. Second, those researchers worked independently using Braun and Clarke’s criterion (‘whether it captures something important in relation to the overall research question’—p 82 25 ) to identify themes. Third, they discussed their initial interpretations with each other and resolved differences through discussion. Fourth, they extracted evidence from the data sources to illustrate and refine each theme. Finally, they presented their list of themes along with illustrative examples to the wider team. Cases used to illustrate themes were systematically fictionalised by changing age, randomly allocating gender and altering clinical details. 26 For example, an acute appendicitis could be changed to acute diverticulitis if the issue was a missed acute abdomen.

These safety themes were then used to sensitise us to seek relevant (confirming and disconfirming) material from our ethnographic and interview datasets. For example, the theme ‘poor communication’ (and subthemes such as ‘failure to seek further clarification’ within this) promoted us to look for examples in our stakeholder interviews of poor communication offered as a cause of safety incidents and examples in our ethnographic notes of good communication (including someone seeking clarification). We used these wider data to add nuance to the initial list of themes.

As a final sense-checking step, the draft findings from this study were shown to each of the six safety experts in our sample and refined in the light of their comments (in some cases, for example, they considered the case to have been overfictionalised, thereby losing key clinical messages; they also gave additional examples to illustrate some of the themes we had identified, which underlined the importance of those themes).

Overview of dataset

The dataset ( table 1 ) consisted of 95 incident reports (see fictionalised examples in box 1 ), plus approximately 400 pages of extracts from interviews, ethnographic fieldnotes and workshop discussions, including situated safety practices (see examples in box 2 ), plus strategic insights relating to policy, organisation and planning of services. Notably, almost all incidents related to telephone calls.

Examples of safety incidents involving death or serious harm in remote encounters

All these cases have been systematically fictionalised as explained in the text.

Case 1 (death)

A woman in her 70s experiencing sudden breathlessness called her GP (general practitioner) surgery. The receptionist answered the phone and informed her that she would place her on the doctor’s list for an emergency call-back. The receptionist was distracted by a patient in the waiting room and did not do so. The patient deteriorated and died at home that afternoon.—NHS Resolution case, pre-2020

Case 2 (death)

An elderly woman contacted her GP after a telephone contact with the out-of-hours service, where constipation had been diagnosed. The GP prescribed laxatives without seeing the patient. The patient self-presented to the emergency department (ED) the following day in obstruction secondary to an incarcerated hernia and died in the operating theatre.—NHS Resolution case, pre-2020

Case 3 (risk to vulnerable patients)

A daughter complained that her elderly father was unable to access his GP surgery as he could not navigate the online triage system. When he phoned the surgery directly, he was directed back to the online system and told to get a relative to complete the form for him.—Complaint to NHS England, 2021

Case 4 (harm)

A woman in her first pregnancy at 28 weeks’ gestation experiencing urinary incontinence called NHS 111. She was taken down by a ‘urinary problems’ algorithm. Both the call handler and the subsequent clinician failed to recognise that she had experienced premature rupture of membranes. She later presented to the maternity department in active labour, and the opportunity to give early steroids to the premature infant was missed.—NHS Resolution case, pre-2020

Case 5 (death)

A doctor called about a 16-year-old girl with lethargy, shaking, fever and poor oral intake who had been unwell for 5 days. The doctor spoke to her older sister and advised that the child had likely glandular fever and should rest. When the parents arrived home, they called an ambulance but the child died of sepsis in the ED.—NHS Resolution case, pre-2020

Case 6 (death)

A 40-year-old woman, 6 weeks after caesarean section, contacted her GP due to shortness of breath, increased heart rate and dry cough. She was advised to get a COVID test and to dial 111 if she developed a productive cough, fever or pain. The following day she collapsed and died at home. The postmortem revealed a large pulmonary embolus. On reviewing the case, her GP surgery felt that had she been seen face to face, her oxygen saturations would have been measured and may have led to suspicion of the diagnosis.—NHS Resolution case, 2020

Case 7 (death)

A son complained that his father with diabetes and chronic kidney disease did not receive any in-person appointments over a period of 1 year. His father went on to die following a leg amputation arising from a complication of his diabetes.—Complaint to NHS England, 2021

Case 8 (death)

A 73-year-old diabetic woman with throat pain and fatigue called the surgery. She was diagnosed with a viral illness and given self-care advice. Over the next few days, she developed worsening breathlessness and was advised to do a COVID test and was given a pulse oximeter. She was found dead at home 4 days later. Postmortem found a blocked coronary artery and a large amount of pulmonary oedema. The cause of death was myocardial infarction and heart failure.—NHS Resolution case, pre-2020

Case 9 (harm)

A patient with a history of successfully treated cervical cancer developed vaginal bleeding. A diagnosis of fibroids was made and the patient received routine care by telephone over the next few months until a scan revealed a local recurrence of the original cancer.—Complaint to NHS England, 2020

Case 10 (death)

A 65-year-old female smoker with chronic cough and breathlessness presented to her GP. She was diagnosed with chronic obstructive pulmonary disease (COPD) and monitored via telephone. She did not respond to inhalers or antibiotics but continued to receive telephone monitoring without further investigation. Her symptoms continued to worsen and she called an ambulance. In the ED, she was diagnosed with heart failure and died soon after.—Complaint to NHS England, 2021

Case 11 (harm)

A 30-year-old woman presented with intermittent episodes of severe dysuria over a period of 2 years. She was given repeated courses of antibiotics but no urine was sent for culture and she was not examined. After 4 months of symptoms, she saw a private GP and was diagnosed with genital herpes.—Complaint to NHS England, 2021

Case 12 (harm)

There were repeated telephone consultations about a baby whose parents were concerned that the child was having a funny colour when feeding or crying. The 6-week check was done by telephone and at no stage was the child seen in person. Photos were sent in, but the child’s dark skin colour meant that cyanosis was not easily apparent to the reviewing clinician. The child was subsequently admitted by emergency ambulance where a significant congenital cardiac abnormality was found.—Complaint to NHS England, 2020 1

Case 13 (harm)

A 35-year-old woman in her third trimester of pregnancy had a telephone appointment with her GP about a breast lump. She was informed that this was likely due to antenatal breast changes and was not offered an in-person appointment. She attended after delivery and was referred to a breast clinic where a cancer was diagnosed.—Complaint to NHS England, 2020

Case 14 (harm)

A 63-year-old woman with a variety of physical symptoms including diarrhoea, hip girdle pain, palpitations, light-headedness and insomnia called her surgery on multiple occasions. She was told her symptoms were likely due to anxiety, but was diagnosed with stage 4 ovarian cancer and died soon after.—Complaint to NHS England, 2021

Case 15 (death)

A man with COPD with worsening shortness of breath called his GP surgery. The staff asked him if it was an emergency, and when the patient said no, scheduled him for 2 weeks later. The patient died before the appointment.—Complaint to NHS England, 2021

Examples of safety practices

Case 16 (safety incident averted by switching to video call for a sick child)

‘I’ve remembered one father that called up. Really didn’t seem to be too concerned. And was very much under-playing it and then when I did a video call, you know this child… had intercostal recession… looked really, really poorly. And it was quite scary actually that, you know, you’d had the conversation and if you’d just listened to what Dad was saying, actually, you probably wouldn’t be concerned.’—GP (general practitioner) interview 2022

Case 17 (‘red flag’ spotted by support staff member)

A receptionist was processing routine ‘administrative’ encounters sent in by patients using AccuRx (text messaging software). She became concerned about a sick note renewal request from a patient with a mental health condition. The free text included a reference to feeling suicidal, so the receptionist moved the request to the ‘red’ (urgent call-back) list. In interviews with staff, it became apparent that there had recently been heated discussion in the practice about whether support staff were adding ‘too many’ patients to the red list. After discussing cases, the doctors concluded that it should be them, not the support staff, who should absorb the risk in uncertain cases. The receptionist said that they had been told: ‘if in doubt, put it down as urgent and then the duty doctor can make a decision.’—Ethnographic fieldnotes from general practice 2023

Case 18 (‘check-in’ phone call added on busy day)

A duty doctor was working through a very busy Monday morning ‘urgent’ list. One patient had acute abdominal pain, which would normally have triggered an in-person appointment, but there were no slots and hard decisions were being made. This patient had had the pain already for a week, so the doctor judged that the general rule of in-person examination could probably be over-ridden. But instead of simply allocating to a call-back, the doctor asked a support staff member to phone the patient, ask ‘are you OK to wait until tomorrow?’ and offer basic safety-netting advice.—Ethnographic fieldnotes from general practice 2023

Case 19 (receptionist advocating on behalf of ‘angry’ walk-in patient)

A young Afghan man with limited English walked into a GP surgery on a very busy day, ignoring the prevailing policy of ‘total triage’ (make contact by phone or online in the first instance). He indicated that he wanted a same-day in-person appointment for a problem he perceived as urgent. A heated exchange occurred with the first receptionist, and the patient accused her of ‘racism’. A second receptionist of non-white ethnicity herself noted the man’s distress and suspected that there may indeed be an urgent problem. She asked the first receptionist to leave the scene, saying she wanted to ‘have a chat’ with the patient (‘the colour of my skin probably calmed him down more than anything’). Through talking to the patient and looking through his record, she ascertained that he had an acute infection that likely needed prompt attention. She tried to ‘bend the rules’ and persuade the duty doctor to see the patient, conveying the clinical information but deliberately omitting the altercation. But the first receptionist complained to the doctor (‘he called us racists’) and the doctor decided that the patient would not therefore be offered a same-day appointment. The second receptionist challenged the doctor (‘that’s not a reason to block him from getting care’). At this point, the patient cried and the second receptionist also became upset (‘this must be serious, you know’). On this occasion, despite her advocacy the patient was not given an immediate appointment.—Ethnographic fieldnotes from general practice 2022

Case 20 (long-term condition nurse visits ‘unengaged’ patients at home)

An advanced nurse practitioner talks of two older patients, each with a long-term condition, who are ‘unengaged’ and lacking a telephone. In this practice, all long-term condition reviews are routinely done by phone. She reflects that some people ‘choose not to have avenues of communication’ (ie, are deliberately not contactable), and that there may be reasons for this (‘maybe health anxiety or just old’). She has, on occasion, ‘turned up’ unannounced at the patient’s home and asked to come in and do the review, including bloods and other tests. She reflects that while most patients engage well with the service, ‘half my job is these patients who don’t engage very well.’—Ethnographic fieldnotes from digitally advanced general practice 2022

Case 21 (doctor over-riding patient’s request for telephone prescribing)

A GP trainee described a case of a 53-year-old first-generation immigrant from Pakistan, a known smoker with hypertension and diabetes. He had booked a telephone call for vomiting and sinus pain. There was no interpreter available but the man spoke some English. He said he had awoken in the night with pain in his sinuses and vomiting. All he wanted was painkillers for his sinuses. The story did not quite make sense, and the man ‘sounded unwell’. The GP told him he needed to come in and be examined. The patient initially resisted but was persuaded to come in. When the GP went to call him in, the man was visibly unwell and lying down in the waiting room. When seen in person, he admitted to shoulder pain. The GP sent him to accident and emergency (A&E) where a myocardial infarction was diagnosed.—Trainee interview 2023

Below, we describe the main themes that were evident in the safety incidents: a challenging organisational and system context, poor communication compounded by remote modalities, limited clinical information, patient and carer burden and inadequate training. Many safety incidents illustrated multiple themes—for example, poor communication and failures of clinical assessment or judgement and patient complexity and system pressures. In the detailed findings below, we illustrate why safety incidents occasionally occur and why they are usually avoided.

The context for remote consultations: system and operational challenges

Introduction of remote triage and expansion of remote consultations in UK primary care occurred at a time of unprecedented system stress (an understaffed and chronically under-resourced primary care sector, attempting to cope with a pandemic). 23 Many organisations had insufficient telephone lines or call handlers, so patients struggled to access services (eg, half of all calls to the emergency COVID-19 telephone service in March 2020 were never answered 7 ). Most remote consultations were by telephone. 27

Our safety incident dataset included examples of technically complex access routes which patients found difficult or impossible to navigate (case 3 in box 1 ) and which required non-clinical staff to make clinical or clinically related judgements (cases 4 and 15). Our ethnographic dataset contained examples of inflexible application of triage rules (eg, no face-to-face consultation unless the patient had already had a telephone call), though in other practices these rules could be over-ridden by staff using their judgement or asking colleagues. Some practices had a high rate of failed telephone call-backs (patient unobtainable).

High demand, staff shortages and high turnover of clinical and support staff made the context for remote encounters inherently risky. Several incidents were linked to a busy staff member becoming distracted (case 1). Telephone consultations, which tend to be shorter, were sometimes used in the hope of improving efficiency. Some safety incidents suggested perfunctory and transactional telephone consultations, with flawed decisions made on the basis of incomplete information (eg, case 2).

Many practices had shifted—at least to some extent—from a demand-driven system (in which every request for an appointment was met) to a capacity-driven one (in which, if a set capacity was exceeded, patients were advised to seek care elsewhere), though the latter was often used flexibly rather than rigidly with an expectation that some patients would be ‘squeezed in’. In some practices, capacity limits had been introduced to respond to escalation of demand linked to overuse of triage templates (eg, to inquire about minor symptoms).

As a result of task redistribution and new staff roles, a single episode of care for one problem often involved multiple encounters or tasks distributed among clinical and non-clinical staff (often in different locations and sometimes also across in-hours and out-of-hours providers). Capacity constraints in onward services placed pressure on primary care to manage risk in the community, leading in some cases to failure to escalate care appropriately (case 6).

Some safety incidents were linked to organisational routines that had not adapted sufficiently to remote—for example, a prescription might be issued but (for various reasons) it could not be transmitted electronically to the pharmacy. Certain urgent referrals were delayed if the consultation occurred remotely (a referral for suspected colon cancer, for example, would not be accepted without a faecal immunochemical test).

Training, supervising and inducting staff was more difficult when many were working remotely. If teams saw each other less frequently, relationship-building encounters and ‘corridor’ conversations were reduced, with knock-on impacts for individual and team learning and patient care. Those supervising trainees or allied professionals reported loss of non-verbal cues (eg, more difficult to assess how confident or distressed the trainee was).

Clinical and support staff regularly used initiative and situated judgement to compensate for an overall lack of system resilience ( box 1 ). Many practices had introduced additional safety measures such as lists of patients who, while not obviously urgent, needed timely review by a clinician. Case 17 illustrates how a rule of thumb ‘if in doubt, put it down as urgent’ was introduced and then applied to avert a potentially serious mental health outcome. Case 18 illustrates how, in the context of insufficient in-person slots to accommodate all high-risk cases, a unique safety-netting measure was customised for a patient.

Poor communication is compounded by remote modalities

Because sense data (eg, sight, touch, smell) are missing, 28 remote consultations rely heavily on the history. Many safety incidents were characterised by insufficient or inaccurate information for various reasons. Sometimes (cases 2, 5, 6, 8, 9, 10 and 11), the telephone consultation was too short to do justice to the problem; the clinician asked few or no questions to build rapport, obtain a full history, probe the patient’s answers for additional detail, confirm or exclude associated symptoms and inquire about comorbidities and medication. Video provided some visual cues but these were often limited to head and shoulders, and photographs were sometimes of poor quality.

Cases 2, 4, 5 and 9 illustrate the dangers of relying on information provided by a third party (another staff member or a relative). A key omission (eg, in case 5) was failing to ask why the patient was unable to come to the phone or answer questions directly.

Some remote triage conversations were conducted using an inappropriate algorithm. In case 4, for example, the call handler accepted a pregnant patient’s assumption that leaking fluid was urine when the problem was actually ruptured membranes. The wrong pathway was selected; vital questions remained unasked; and a skewed history was passed to (and accepted by) the clinician. In case 8, the patient’s complaint of ‘throat’ pain was taken literally and led to ‘viral illness’ advice, overlooking a myocardial infarction.

The cases in box 2 illustrate how staff compensated for communication challenges. In case 16, a GP plays a hunch that a father’s account of his child’s asthma may be inaccurate and converts a phone encounter to video, revealing the child’s respiratory distress. In case 19 (an in-person encounter but relevant because the altercation occurs partly because remote triage is the default modality), one receptionist correctly surmises that the patient’s angry demeanour may indicate urgency and uses her initiative and interpersonal skills to obtain additional clinical information. In case 20, a long-term condition nurse develops a labour-intensive workaround to overcome her elderly patients’ ‘lack of engagement’. More generally, we observed numerous examples of staff using both formal tools (eg, see ‘red list’ in case 17) and informal measures (eg, corridor chats) to pass on what they believed to be crucial information.

Remote consulting can provide limited clinical information

Cases 2 and 4–14 all describe serious conditions including congenital cyanotic heart disease, pulmonary oedema, sepsis, cancer and diabetic foot which would likely have been readily diagnosed with an in-person examination. While patients often uploaded still images of skin lesions, these were not always of sufficient quality to make a confident diagnosis.

Several safety incidents involved clinicians assuming that a diagnosis made on a remote consultation was definitive rather than provisional. Especially when subsequent consultations were remote, such errors could become ingrained, leading to diagnostic overshadowing and missed or delayed diagnosis (cases 2, 8, 9, 10, 11 and 13). Patients with pre-existing conditions (especially if multiple or progressive), the very young and the elderly were particularly difficult to assess by telephone (cases 1, 2, 8, 10, 12 and 16). Clinical conditions difficult to assess remotely included possible cardiac pain (case 8), acute abdomen (case 2), breathing difficulties (cases 1, 6 and 10), vague and generalised symptoms (cases 5 and 14) and symptoms which progressed despite treatment (cases 9, 10 and 11). All these categories came up repeatedly in interviews and workshops as clinically risky.

Subtle aspects of the consultation which may have contributed to safety incidents in a telephone consultation included the inability to fully appraise the patient’s overall health and well-being (including indicators relevant to mental health such as affect, eye contact, personal hygiene and evidence of self-harm), general demeanour, level of agitation and concern, and clues such as walking speed and gait (cases 2, 5, 6, 7, 8, 10, 12 and 14). Our interviews included stories of missed cases of new-onset frailty and dementia in elderly patients assessed by telephone.

In most practices we studied, most long-term condition management was undertaken by telephone. This may be appropriate (and indeed welcome) when the patient is well and confident and a physical examination is not needed. But diabetes reviews, for example, require foot examination. Case 7 describes the deterioration and death of a patient with diabetes whose routine check-ups had been entirely by telephone. We also heard stories of delayed diagnosis of new diabetes in children when an initial telephone assessment failed to pick up lethargy, weight loss and smell of ketones, and point-of-care tests of blood or urine were not possible.

Nurses observed that remote consultations limit opportunities for demonstrating or checking the patient’s technique in using a device for monitoring or treating their condition such as an inhaler, oximeter or blood pressure machine.

Safety netting was inadequate in many remote safety incidents, even when provided by a clinician (cases 2, 5, 6, 8, 10, 12 and 13) but especially when conveyed by a non-clinician (case 15). Expert interviewees identified that making life-changing diagnoses remotely and starting patients on long-term medication without an in-person appointment was also risky.

Our ethnographic data showed that various measures were used to compensate for limited clinical information, including converting a phone consultation to video (case 16), asking the patient if they felt they could wait until an in-person slot was available (case 18), visiting the patient at home (case 20) and enacting a ‘if the history doesn’t make sense, bring the patient in for an in-person assessment’ rule of thumb (case 21). Out-of-hours providers added examples of rules of thumb that their services had developed over years of providing remote services, including ‘see a child face-to-face if the parent rings back’, ‘be cautious about third-party histories’, ‘visit a palliative care patient before starting a syringe driver’ and ‘do not assess abdominal pain remotely’.

Remote modalities place additional burdens on patients and carers

Given the greater importance of the history in remote consultations, patients who lacked the ability to communicate and respond in line with clinicians’ expectations were at a significant disadvantage. Several safety incidents were linked to patients’ limited fluency in the language and culture of the clinician or to specific vulnerabilities such as learning disability, cognitive impairment, hearing impairment or neurodiversity. Those with complex medical histories and comorbidities, and those with inadequate technical set-up and skills (case 3), faced additional challenges.

In many practices, in-person appointments were strictly limited according to more or less rigid triage criteria. Some patients were unable to answer the question ‘is this an emergency?’ correctly, leading to their condition being deprioritised (case 15). Some had learnt to ‘game’ the triage system (eg, online templates 29 ) by adapting their story to obtain the in-person appointment they felt they needed. This could create distrust and lead to inaccurate information on the patient record.

Our ethnographic dataset contained many examples of clinical and support staff using initiative to compensate for vulnerable patients’ inability or unwillingness to take on the additional burden of remote modalities (cases 19 and 20 in Box 2 30 31 ).

Training for remote encounters is often inadequate

Safety incidents highlighted various training needs for support staff members (eg, customer care skills, risks of making clinical judgements) and clinicians (eg, limitations of different modalities, risks of diagnostic overshadowing). Whereas out-of-hours providers gave thorough training to novice GPs (covering such things as attentiveness, rapport building, history taking, probing, attending to contextual cues and safety netting) in telephone consultations, 32–34 many in-hours clinicians had never been formally taught to consult by telephone. Case 17 illustrates how on-the-job training based on acknowledgement of contextual pressures and judicious use of rules of thumb may be very effective in averting safety incidents.

Statement of principal findings

An important overall finding from this study is that examples of deaths or serious harms associated with remote encounters in primary care were extremely rare, amounting to fewer than 100 despite an extensive search going back several years.

Analysis of these 95 safety incidents, drawn from multiple complementary sources, along with rich qualitative data from ethnography, interviews and workshops has clarified where the key risks lie in remote primary care. Remote triage and consultations expanded rapidly in the context of the COVID-19 crisis; they were occurring in the context of resource constraints, understaffing and high demand. Triage and care pathways were complex, multilayered and hard to navigate; some involved distributed work among multiple clinical and non-clinical staff. In some cases, multiple remote encounters preceded (and delayed) a needed in-person assessment.

In this high-risk context, safety incidents involving death or serious harm were rare, but those that occurred were characterised by a combination of inappropriate choice of modality, poor rapport building, inadequate information gathering, limited clinical assessment, inappropriate clinical pathway (eg, wrong algorithm) and failure to take account of social circumstances. These led to missed, inaccurate or delayed diagnoses, underestimation of severity or urgency, delayed referral, incorrect or delayed treatment, poor safety netting and inadequate follow-up. Patients with complex or multiple pre-existing conditions, cardiac or abdominal emergencies, vague or generalised symptoms, safeguarding issues and failure to respond to previous treatment, and those who (for any reason) had difficulty communicating, seemed particularly at risk.

Strengths and limitations of the study

The main strength of this study was that it combined the largest Safety I study undertaken to date of safety incidents in remote primary care (using datasets which have not previously been tapped for research), with a large, UK-wide ethnographic Safety II analysis of general practice as well as stakeholder interviews and workshops. Limitations of the safety incident sample (see final column in table 1 ) include that it was skewed towards very rare cases of death and serious harm, with relatively few opportunities for learning that did not result in serious harm. Most sources were retrospective and may have suffered from biases in documentation and recall. We also failed to obtain examples of safeguarding incidents (which would likely turn up in social care audits). While all cases involved a remote modality (or a patient who would not or could not use one), it is impossible to definitively attribute the harm to that modality.

Comparison with existing literature

This study has affirmed previous findings that processes, workflows and training in in-hours general practice have not adapted adequately to the booking, delivery and follow-up of remote consultations. 24 35 36 Safety issues can arise, for example, from how the remote consultation interfaces with other key practice routines (eg, for making urgent referrals for possible cancer). The sheer complexity and fragmentation of much remote and digital work underscores the findings from a systematic review of the importance of relational coordination (defined as ‘a mutually reinforcing process of communicating and relating for the purpose of task integration ’ (p 3) 37 ) and psychological safety (defined as ‘people’s perceptions of the consequences of taking interpersonal risks in a particular context such as a workplace ’ (p 23) 38 ) in building organisational resilience and assuring safety.

The additional workload and complexity associated with running remote appointments alongside in-person ones is cognitively demanding for staff and requires additional skills for which not all are adequately trained. 24 39 40 We have written separately about the loss of traditional continuity of care as primary care services become digitised, 41–43 and about the unmet training needs of both clinical and support staff for managing remote and digital encounters. 24

Our findings also resonate with research showing that remote modalities can interfere with communicative tasks such as rapport building, establishing a therapeutic relationship and identifying non-verbal cues such as tearfulness 35 36 44 ; that remote consultations tend to be shorter and feature less discussion, information gathering and safety netting 45–48 ; and that clinical assessment in remote encounters may be challenging, 27 49 50 especially when physical examination is needed. 35 36 51 These factors may rarely contribute to incorrect or delayed diagnoses, underestimation of the seriousness or urgency of a case, and failure to identify a deteriorating trajectory. 35 36 52–54

Even when systems seem adequate, patients may struggle to navigate them. 23 30 31 This finding aligns with an important recent review of cognitive load theory in the context of remote and digital health services: because such services are more cognitively demanding for patients, they may widen inequities of access. 55 Some patients lack navigating and negotiating skills, access to key technologies 13 36 or confidence in using them. 30 35 The remote encounter may require the patient to have a sophisticated understanding of access and cross-referral pathways, interpret their own symptoms (including making judgements about severity and urgency), obtain and use self-monitoring technologies (such as a blood pressure machine or oximeter) and convey these data in medically meaningful ways (eg, by completing algorithmic triage forms or via a telephone conversation). 30 56 Furthermore, the remote environment may afford fewer opportunities for holistically evaluating, supporting or safeguarding the vulnerable patient, leading to widening inequities. 13 35 57 Previous work has also shown that patients with pre-existing illness, complex comorbidities or high-risk states, 58 59 language non-concordance, 13 35 inability to describe their symptoms (eg, due to autism 60 ), extremes of age 61 and those with low health or system literacy 30 are more difficult to assess remotely.

Lessons for safer care

Many of the contributory factors to safety incidents in remote encounters have been suggested previously, 35 36 and align broadly with factors that explain safety incidents more generally. 53 62 63 This new study has systematically traced how upstream factors may, very rarely, combine to contribute to avoidable human tragedies—and also how primary care teams develop local safety practices and cultures to help avoid them. Our study provides some important messages for practices and policymakers.

First, remote encounters in general practice are mostly occurring in a system designed for in-person encounters, so processes and workflows may work less well.

Second, because the remote encounter depends more on history taking and dialogue, verbal communication is even more mission critical. Working remotely under system pressures and optimising verbal communication should both be priorities for staff training.

Third, the remote environment may increase existing inequities as patients’ various vulnerabilities (eg, extremes of age, poverty, language and literacy barriers, comorbidities) make remote communication and assessment more difficult. Our study has revealed impressive efforts from staff to overcome these inequities on an individual basis; some of these workarounds may become normalised and increase efficiency, but others are labour intensive and not scalable.

A final message from this study is that clinical assessment provides less information when a physical examination (and even a basic visual overview) is not possible. Hence, the remote consultation has a higher degree of inherent uncertainty. Even when processes have been optimised (eg, using high-quality triage to allocate modality), but especially when they have not, diagnoses and assessments of severity or urgency should be treated as more provisional and revisited accordingly. We have given examples in the Results section of how local adaptation and rule breaking bring flexibility into the system and may become normalised over time, leading to the creation of locally understood ‘rules of thumb’ which increase safety.

Overall, these findings underscore the need to share learning and develop guidance about the drivers of risk, how these play out in different kinds of remote encounters and how to develop and strengthen Safety II approaches to mitigate those risks. Table 2 shows proposed mitigations at staff, process and system levels, as well as a preliminary list of suggestions for patients, which could be refined with patient input using codesign methods. 64

Reducing safety incidents in remote primary care

Unanswered questions and future research

This study has helped explain where the key risks lie in remote primary care encounters, which in our dataset were almost all by telephone. It has revealed examples of how front-line staff create and maintain a safety culture, thereby helping to prevent such incidents. We suggest four key avenues for further research. First, additional ethnographic studies in general practice might extend these findings and focus on specific subquestions (eg, how practices identify, capture and learn from near-miss incidents). Second, ethnographic studies of out-of-hours services, which are mostly telephone by default, may reveal additional elements of safety culture from which in-hours general practice could learn. Third, the rise in asynchronous e-consultations (in which patients complete an online template and receive a response by email) raises questions about the safety of this new modality which could be explored in mixed-methods studies including quantitative analysis of what kinds of conditions these consultations cover and qualitative analysis of the content and dynamics of the interaction. Finally, our findings suggest that the safety of new clinically related ‘assistant’ roles in general practice should be urgently evaluated, especially when such staff are undertaking remote assessment or remote triage.

Ethics statements

Patient consent for publication.

Not applicable.

Ethics approval

Ethical approval was granted by the East Midlands—Leicester South Research Ethics Committee and UK Health Research Authority (September 2021, 21/EM/0170 and subsequent amendments). Access to the NHS Resolution dataset was obtained by secondment of the RP via honorary employment contract, where she worked with staff to de-identify and fictionalise relevant cases. The Remote by Default 2 study (referenced in main text) was co-designed by patients and lay people; it includes a diverse patient panel. Oversight was provided by an independent external advisory group with a lay chair and patient representation. A person with lived experience of a healthcare safety incident (NS) is a co-author on this paper and provided input to data analysis and writing up, especially the recommendations for patients in table 2 .

Acknowledgments

We thank the participating organisations for cooperating with this study and giving permission to use fictionalised safety incidents. We thank the participants in the ethnographic study (patients, practice staff, policymakers, other informants) who gave generously of their time and members of the study advisory group.

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X @dakinfrancesca, @trishgreenhalgh

Contributors RP led the Safety I analysis with support from AC. The Safety II analysis was part of a wider ethnographic study led by TG and SS, on which all other authors undertook fieldwork and contributed data. TG and RP wrote the paper, with all other authors contributing refinements. All authors checked and approved the final manuscript. RP is guarantor.

Funding Funding was from NIHR HS&DR (grant number 132807) (Remote by Default 2 study) and NIHR School for Primary Care Research (grant number 594) (ModCons study), plus an NIHR In-Practice Fellowship for RP.

Competing interests RP was National Professional Advisor, Care Quality Commission 2017–2022, where her role included investigation of safety issues.

Provenance and peer review Not commissioned; externally peer reviewed.

Linked Articles

Editorial Examining telehealth through the Institute of Medicine quality domains: unanswered questions and research agenda Timothy C Guetterman Lorraine R Buis BMJ Quality & Safety 2024; 33 552-555 Published Online First: 09 May 2024. doi: 10.1136/bmjqs-2023-016872

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Why Learn Creative Writing?

The Basics of a Writing Workshop

The Benefits of Creative Writing

2. Why Learn Creative Writing: Job Success

3. Why Learn Creative Writing: Improved Thinking Skills

4. Why Learn Creative Writing: Empathy

5. Why Learn Creative Writing: It’s Fun!

The Importance of Creative Writing

Jobs for Creative Writers

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Communications/Public Relations Specialist

Reasons to Learn Creative Writing: Finding a Writing Community

Sean Glatch

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Creative Writing: What It Is and Why It Matters

How We Define Creative Writing

The Importance of Creative Writing

Creative Writing: A Path to Mental and Emotional Wellness

Stress Relief and Emotional Catharsis

Improved Communication and Self-Expression

Increased Empathy and Understanding of Others

The Professional Benefits of Creative Writing

Preparing Students for Careers in Writing, Editing, and Publishing

Improving Skills in Storytelling and Marketing for Various Careers

Enhancing Team Collaboration and Leadership Skills

Uncovering the Power of Creative Writing

Preserving Cultural Heritage with Creative Writing

Promoting Social Change & Activism with Creative Writing

Fostering Creativity & Innovation with Creative Writing

Frequently Asked Questions

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What is the importance of imagery in creative writing?

What are the elements of creative writing?

What’s the difference between creative writing and other types of writing?

What is the golden rule of creative writing?

How important is creativity in writing?

Why is creative writing so important?

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8 Good Reasons to Study Creative Writing

1. Enhancing Writing Skills

2. Encouraging Critical Thinking

3. Fostering a Sense of Community

4. Providing Access to Experienced Instructors

5. Building a Writing Routine

6. Enhancing Emotional Intelligence

7. Boosting Confidence

8. Offering a Creative Outlet

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Why the teaching of creative writing matters

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Casual Facilitator: GERRIC Student Programs - Arts, Design and Architecture

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How Creative Writing Can Increase Students’ Resilience

Fostering a growth mindset

Maintaining a hopeful outlook

Practicing kindness

Reaping the benefits

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