Abstract: This upper-division writing course in public health offers the opportunity for learners to engage with a variety of texts in multiple genres that cover wide-ranging topics. Reflective writing assignments in similar courses also align with scholarship on the value of reflective writing in the health sciences (and across all disciplines). When supportively scaffolded, reflections are even more empowering and important to students, because in-class and write-to-learn activities prepare students to engage with topics that arise from considering the end of life. When student choice informs the reflections, learners are encouraged to think empathetically and existentially about how their complex cultural identity informs their beliefs around well-being, end of life, grief, and loss, and to consider the choices they want to make to build healthy communities and live a meaningful life.

Health Promotion Sciences is the largest department in the Mel & Enid Zuckerman College of Public Health (MEZCOPH) at the University of Arizona, which offers a BS in Public Health and a BA in Wellness and Health Promotion Practice. Public Health Narratives (HPS 307) is the departmental offering that Laura created in Spring 2020, and it features wide-ranging narratives from across public health, which is interdisciplinary in nature and relies on strong writing and communication skills regardless of specialty. HPS 307 is an in-person, process-oriented writing course for upper-division undergraduates with an enrollment of 40; it fulfills the upper-division writing requirement.

Whereas many courses in MEZCOPH require writing assignments or qualify as writing-attribute courses (University of Arizona n.d.), HPS 307 is unique because it centers public health stories and features an instructor who has trained in writing pedagogy and practices within Writing Across the Curriculum (WAC) and writing pedagogy education (WPE) communities. It also incorporates undergraduate TAs who have successfully completed the course.¹ Students read texts that illustrate public health issues through different genres and viewpoints. The course requires significant critical discourse around social location, cultural capital, community, systems, and belonging, and students investigate and unpack their own positionality and implicit biases (Santa Maria 2024) with assignments that invite them to critically examine how their identities shape their engagement with the world. With a focus on impactful storytelling and effective rhetorical strategies in texts that elicit emotional responses, HPS 307 puts a face to the statistics that students learn about in other coursework.

“To Be Human is To Be Limited” is the third reflection essay assigned in HPS 307. Below, we contextualize the learning community for the reflection assignment, situate the assignment within relevant theoretical frameworks, detail the reflection essay’s role within the course, and integrate Alyssa’s and Sylvia’s perspectives as former students and former TAs. The essay draws on anecdotal evidence from students and student writing, and we close with suggestions for integrating reflection into a variety of courses.

Learning Objectives for HPS 307

The course identifies public health writing outcomes, whose “core function is to inform, educate, and empower,” aligning with Boston University Public Health Writing Guide recommendations (Beard and Price 2018, March 27, 3). The learning objectives also highlight self-awareness as a crucial component of all writing, especially reflective writing. Class discussions emphasize the importance of self-awareness, while regular large- and small-group activities (write-to-learn tasks, drafting, workshops) help learners practice rhetorical analysis, shared problem solving, and compassionate, layered responses to the complex issues that arise in public health. Learning objectives for HPS 307 include:

• Develop a sense of public health narratives and the skills necessary to craft a persuasive argument through critical thinking, reading, and writing

• Engage with a variety of public health narratives, including books, articles, podcasts, documentary films, and narrative television episodes

• Assess various writing techniques and rhetorical strategies to analyze their ability to present public health concerns to a broad audience

• Integrate reflective writing practices that empower public health professionals

• Identify, develop, and strengthen a unique and individual writing voice

During class discussions, we tackle the question of how to persuade people to care about issues that may not affect them personally. To do this, we examine readings that blend compelling storytelling with research and evidence-based conclusions as well as memorable images and language. Students share their emotional and intellectual reactions, and we engage together in detailed analysis to determine how language and style choices evoke feelings, change perspectives, and ultimately transform the world.

Theoretical Frames

The theoretical frames that inform HPS 307 build on affective science, social-emotional principles, theories of belonging, and evidence-based teaching practices (Adichie 2009, July; Cavanagh 2016; Denial 2024; Collins 1993; hooks 1994; Lang 2016). Asset-based class activities and prewriting prompts scaffold “To Be Human,” drawing on concepts like community cultural wealth (Yosso 2005) and composting (Goldberg 2016) to help students generate ideas and develop a writing process. For instance, Goldberg stresses that writing is a way for learners to understand their complex identities through time and reflection (p. 15). Adichie (2009, July) advocates an understanding that humans are never reducible to a single story, while Collins (1993) encourages an understanding of identity as a collection of all our experiences, a set of “both/and identities” (p. 27) that acknowledge our complexity as humans. Godbee and Diab (2025) similarly emphasize both/and identities in their work on accountability practices. Their framework informs this class and this assignment, and as a class we question “typical conditioned patterns, which can lead us to glance and go” (p. 397). Through multiple reflections, students build awareness of the rich funds of knowledge (Yosso 2005) they bring to class and use in writing about public health interventions.

The value of reflective writing in higher education dates to Dewey (1910), whose pioneering work foregrounded the knowledge building that results from consistent, guided acts of metacognitive reflection. Scholars across disciplines have advanced reflective writing as an impactful way for students to make meaning of their education (e.g., Boud, Keogh, and Walker 1985; Kolb 1984; Schön 1983; Yancey 1998). Yancey’s (2016) scholarship emphasizes that “reflection contributes to self-efficacy precisely because it helps us understand that we have learned (even if not always successfully); how we have learned; and how we might continue to learn (p. 8). Within the formal class setting, Alyssa observes that the reflection process can initially feel foreign and unnatural. However, within a classroom culture of trust, skilled facilitation, and consistent group processing and feedback, individual reflections allow students to more confidently tap into different forms of writing, thinking, and feeling. Many scholars have noted that reflective writing supports students in building critical thinking and developing metacognitive capacities that enhance their development as scholars, professionals, and individuals (Ramlal and Augustin 2020; Yeh et al. 2023).

Scholarship within health sciences often focuses on the value of reflection in applied practice or in post-baccalaureate degrees (Jayatilleke and Mackie 2013; Mann, Gordon, and MacLeod 2009; Pham, Cunningham, and Humphries 2023). In medicine, Ménard and Ratnapalan (2013) assert that reflection shouldn’t be an abstraction, but that individuals and teams should utilize reflection to improve practical application of knowledge (p. 105). Mann, Gordon, and MacLeod’s (2009) review of reflection in health professions underscores its recognized value in helping students form professional identities and learn self-regulation (p. 596). Jayatilleke and Mackie (2013) note that the goal of reflection for ongoing education should be “to improve practice and learn from relevant experiences … moving beyond pure description” (p. 310). Pham, Cunningham, and Humphries (2023) likewise argue that reflection helps with “navigating the complex environment of public health practice, skill building, [and] critical self-reflection” (p. 1). Meanwhile, Beard and Price (2018, March 27) prioritize synthesizing individual experiences with funds of knowledge to help students in “making connections, clarifying concepts, examining successes and failures, and becoming more self-aware” (p. 49). Sylvia’s experience additionally suggests that the skills students gain from reflection are tangible and can be applied to other situations, whether academic or professional. Through guided reflection, students not only understand themselves better through metacognitive practices, but they build critical thinking skills that the assignments enforce.

Sustained Reflection in HPS 307

“To Be Human” invites students to think holistically about how they make meaning in their lives, considering how they spend their (free) time and what activities make up a “good day.” It supports them as they work toward bell hooks’s (1994) definition of education as a practice of freedom, and it empowers learners to choose their own audience, not exclusively an academic audience. In class, Laura communicates the importance of reflection in building self-awareness, connecting with audiences, and bringing value to students’ different kinds of languaging Inoue 2021, June 3. She works from the perspective that reflection assignments encourage learners to recognize and deconstruct their “default position” (Adichie 2009, July)—the unexamined positionality we form based on the dominant cultural narratives we consumed growing up (Collins 1993, 10). Inoue (2021, June 3) cautions that the default position in traditional writing classrooms “mimic[s] an elite, White, middle- or upper-class monolingual English language”. Learning about default position does not press students to judge their past experiences or their current selves, but rather helps them understand their starting point. Starting with default position builds recognition so students can develop self-awareness about who they are and what they bring into different discourse communities.

The assignment and scaffolding occur during week 11 of the 16-week semester. By this point, students have written two earlier reflections that prepare them to practice metacognition as they explore and articulate their complex cultural identities and positions. Students benefit significantly from in-person sessions that feature small-group and whole class discussions, directed prewriting, peer-review workshops, and presentations from the teaching team.

The foundational text for the “To Be Human” essay is a podcast interview with physician, researcher, and writer Atul Gawande (Tippett, 2024). Gawande’s Being Mortal: Medicine and What Matters in the End is a moving and eloquent exploration of end-of-life care in the United States that urges readers to consider how we make meaning in our lives through our last days. Before class, students listen to the podcast and complete a discussion board, writing about grief and loss in American culture.² Laura opens the class session with a reading of the poem “What the Living Do” by Marie Howe (1997). Next, students create a cluster map at their tables (of 4 to 6 learners), focusing on ideas from the podcast. Student groups gravitate toward similar themes in their maps: quality of life, comfort and care, grief and loss. An open-ended whole-class discussion focuses on the stigma surrounding grief and loss in American culture. Students also share perspectives on a “good day” as it contributes to quality of life (vs. quantity as the only measure). We wrap up the discussion with a choice of prewriting prompts that zoom in on details as the building blocks for reflections.

The goal of “To Be Human” is for students to think about how their perspective has changed by considering concepts introduced in the podcast and discussion. Learners practice what Yancey (2016) deems “constructive reflection, the process of developing a cumulative, multi-selved, multi-voiced identity, which takes place between and among composing events” (p. 4; emphasis in original). Most students in HPS 307 are traditionally aged college students, so they situate their feelings within the life changes that accompany moving from high school narratives to the independence and novelty of college. Assignment prompts transfer successfully for non-traditional students as a call to ponder the life changes they have recently experienced as they balance their degree with other work, personal, and care-giving commitments. Successful responses feature specific details, demonstrate critical thinking, showcase growing self-awareness, and highlight original thinking expressed through a student’s unique writing voice.

Student Responses to “To Be Human”

Laura first taught “To Be Human” in Spring 2020 as COVID forced her to radically reconfigure daily activities and reconsider the role of family and community. Even after five years, students still carry the scars of that time, particularly in their insecurity about speaking up in class and their generational anxieties about forming friendships and interacting face-to-face. Yet by week 11, students have built skills and stamina for reflective writing, and they are quite open and vulnerable with their writing. Many students have commented that “To Be Human” was their favorite writing project from the semester, and one student even revised a version of her reflection to read at her grandmother’s funeral.³

When Alyssa looks back on her experience, she notes: Almost a year and a half after I submitted my draft, I still consider “To Be Human” one of the most impactful assignments of my undergraduate career. I have found that intentional acts of reflection require a level of intrinsic motivation and free time that I, and many students, do not have. Having reflection as a requirement gave me dedicated time and an incentive to process my complex identities, feelings of grief, goals for well-being, and experience living through unprecedented socio-political events. I was able to think about my individual beliefs of well-being and how they exist within a larger system. This line of existential thought could have led to spiraling ruminations over grief and loss, but the prompt’s emphasis on “well-being” and “a good day” prevented this.

The prompt didn’t inspire an unreasonable amount of optimism, but I was able to process toward a hopeful conclusion. My ability to tap into my emotions and share my stories was beneficial, and these are also crucial skills for any student. As we interrogate how our experiences and identities shape our core beliefs, we strengthen our empathy while gaining storytelling skills. We can practice how to best engage audiences, when to incorporate anecdotes, and when to integrate evidence. These technical storytelling skills can similarly be applied when incorporating the stories of others into our writing. Reflection is as much of a technical exercise as it is an exercise of empathy.

For Sylvia, her growth began with her home life: My mother worked in geriatric care, so listening to Gawande discuss the importance of a “good day” affirmed my experience with end-of-life care. Yet as I was writing “To Be Human” (one of the most important pieces I’ve written academically or personally), I thought deeply about how unrelatable this might be to my peers. The goal of this essay was to open our eyes to an often-ignored section of public health and explore our connections with older adult care, grief and loss, and end-of-life in a way that most of us have never been able to, due to societal or cultural pressures. We were able to dig through the trench of grief and loss, while considering the positives of “a good day” and reframing end-of-life for patients and their community.

My tablemates and I came together once the reflection was submitted and discussed our experiences. We agreed that the whole assignment resonated, whether we were able to get something off our chests or just felt the cathartic release of finally being able to understand grief in a new way. We agreed that the American push for ignoring grief is unhealthy, and our own reflections helped us reframe what a better outlook looks like. Being strategically prompted to recognize that our struggles, and other’s struggles, are systemic offered us the opportunity to grow into more informed, analytical, and empathetic students.

Other student essays demonstrate how reflective writing encourages what Godbee and Diab (2025) name as accountability practices—prioritizing both/and thinking through “rehearsal (try-try again) and sustained critical reflection” (p. 401). This kind of writing changes students’ metacognitive approach to learning. As former HPS 307 student Kassandra Gordon (2025) wrote,⁴ “Repeated reflection … helped me understand that writing itself is a space where thinking happens. Therefore, writing became less about arriving at clean conclusions and more about working through uncertainty in a productive way.” When students are invited to make meaning of their learning through reflection, it fosters an invitation to share, witness, and testify (Godbee and Diab 2025, 399) to the experiences that build their funds of knowledge and prepare them to make change in the world.

Instructors in many disciplines could enhance their curriculum–and their relational connections with students–through reflective writing assignments that help students do this meaning-making in personal, vulnerable, sometimes quiet, and powerful ways. “To Be Human” elevates the stakes for students to build self-awareness and perspective in ways that really matter to them. HPS 307 student Quinten McCrillis (2025) frames this meaning-making as an issue of caring:

As someone who is trying to grow as a writer, I was able to take away the ability of trying to get someone to care. … This was a very different switch as a writer because I had to use my personal experience … to relate to my audience. … [This] was the most important thing I took away in this class. Getting someone to care and connect with your writing is going to be so much more impactful than just writing up a boring story, even if it is really eye opening

So many students resist writing or feel afraid of it as a mode of learning, a potent and profound tool for knowledge and self-knowledge. This is even more pronounced with the ever-present shadow of AI looming over classrooms, providing a logical temptation for students to shortcut their academic learning and personal growth. But, as Quinten suggests, reflection taps into something “eye opening” for students; it transcends “just writing up a boring story.” And, as Yancey (2016) asserts, it “offers much more to writers and teachers of writers than has previously been assumed” (p. 11). The need for metacognitive reflection will only increase as students inevitably utilize AI to supplement learning. With guided reflection like “To Be Human,” metacognitive skills are enhanced and learners emerge with a writing process that values individual perspective and unique writing voice.

Developing a new perspective and process has been possible in HPS 307 even for learners whose previous writing was less sophisticated and nuanced. Because the reflection occurs toward the end of the semester, students have built skills in analysis, evidence, self-awareness, and voice. Anecdotal evidence suggests that developing learners and less confident writers can still find access points to success through guided metacognitive reflection. Sylvia sums it up this way: Using real-life examples in reflections challenges students to reframe an actual experience with the tools Gawande (2014) proposes. Doing so allows learners to process feelings they may not have known they had, which is the inevitable nature of reflective writing, and why all the reflections in HPS 307 are so important. They mean something real to every writer.

Further Applications & Conclusion

This assignment is applicable to courses that touch on loss, mourning, or grief. More broadly, it works well alongside analytical writing assignments because students can transfer skills of analysis, close reading, and self-awareness. Assignments like “To Be Human” lay the groundwork for students who will become future professionals, from STEM to liberal arts. Alyssa and Sylvia valued that, for an undergraduate generation defined by AI writing, HPS 307 prioritized the skill of intentional reflection. Reflection is crucial not just for students' technical writing abilities and critical thinking skills, but also for their ability to exercise compassion more generously and to process their experiences. For Laura, reading these reflections deepens her connection to students and gives her hope. Reflective writing allows students to stay rooted in their humanity. This process in itself is a radical step in the right direction.

When we implement effective reflection assignments, students are compelled into higher level, subtle thinking, and they demonstrate sustained engagement with the “big questions” within their discipline (Bean and Melzer 2021, 1). Students learn to use original detail to give their writing “believability and truthfulness” (Goldberg 2016, 43), pushing beyond vagueness into a “knowledge-making activity” that is “critical in helping learners secure their learning” (Yancey 2016, 8). For HPS 307 students, who will shape community dialogue and practice healthcare and health interventions in the future, honing their ability to metacognitively reflect will help them grow their intellect, skills, and humility.

“To Be Human” is a letting go for students: Rather than feeling bound to a sterile academic context, learners nurture their individual writing voice, choose their audience, and divest themselves of the “right” way to sound. By prompting students to reflect on life and death topics, they are gently urged outside their comfort zones and encouraged to write about topics that may have previously been considered off-limits. It allows students to bring some heart into their work. Ultimately, the process of completing “To Be Human” affirms the value of reflection as a tool for individual processing and an exercise to equip students to incorporate storytelling into their professional lives.

Acknowledgements

Thank you to the University of Arizona Writing Across the Curriculum Fellowship and Program. I love being in community with you! Thank you to the HPS 307 students in Spring 2024, Fall 2024, and Spring 2025, semesters when Alyssa and Sylvia either were enrolled or served as preceptors. Thank you to former students Kassandra Gordon and Quinten McCrillis for allowing us to share excerpts from their writing.

ASSIGNMENT Reflection 3: To Be Human is To Be Limited

The podcast interview, “On Mortality and Meaning,” with Atul Gawande (conducted by Krista Tippett, 2024, from the On Being Project) focuses on how physicians treat patients, particularly at the end of life. More broadly, Gawande is speaking to listeners of the podcast; thus, Gawande invites us to consider how we can think more holistically about the quality of our daily lives. After listening to “On Mortality and Meaning,” responding on our Discussion Board, and participating our class discussion, you will write a reflection that synthesizes ideas from this podcast with your own experiences.

1. Identify the audience you are writing for in this assignment.

   You will choose a specific, narrow audience for this essay that will empower you to explore these topics with vulnerability and honesty. Choose an audience that will allow you to engage with the metacognitive process of thinking about how your thinking has changed after listening to and discussing this podcast.

2. Write your reflection.

   The goal of this reflection is for you to think about how your perspective has changed by considering concepts introduced in the podcast. Consider if and/or how your thinking has changed over the past several years, especially considering the collective grief and loss we experienced through the pandemic. You may also want to consider feelings you may have experienced as you have moved from one phase of life to another with your college experience. How have these factors changed how you now think about well-being, end of life, grief, and/or loss?

Consider the following prompts and observations from the podcast. You do not need to respond to all prompts specifically and/or answer all of them. These are potential jumping off points.

• Your definition of well-being

• An exploration of what a good day looks like for you

• Contemplating the idea of “how we spend our days is how we spend our lives”

• Exploring the idea, “To be human is to be limited”

Format

• 700-800 words

• Use APA format for title page, running header & page #s

• Use APA-formatted in-text citations for all textual evidence

• Include an APA-formatted References list

References

Notes