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This chapter describe a Storytelling and Narrative Medicine pilot study which focused on communication in therapeutic settings. The research was carried out by a group of Italian Health Care professionals (HCP) from Calambrone Institute for Rehabilitation (IRC), at the IRCCS Stella Maris Foundation, along with a group of parents of patients with disabilities. However, because of the Covid-19 outbreak in Italy, many of the participants found themselves in lockdown in their own homes with their children. To evaluate the efficacy of storytelling as a tool for emotional and communication support, the authors submitted to both the HCP and parents two original online surveys to get information on their current emotional state. The assessed areas were personal stress, the relationship with children and family members, and the relationship with colleagues and professionals. The chapter focuses on emotional and psychological consequences that lack of social and therapeutic interactions might have produced. This short but effective educational intervention gives skills and knowledge to structure one's feelings and thoughts in a narrative form, equipping the participants with the resources to perceive themselves and their life experiences as the elements of the story. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
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In recent years, the field of Narrative Pharmacy was introduced, which particularly addresses the pharmacist not only to guide a relationship of listening to and caring for the patient but also to strengthen and motivate toward the profession, improve relationships with colleagues, enhance the ability to teamwork, and understand emotions. In this paper, we report the analysis behind the construction of the Value Chart from the personal narratives of members of the Italian Society of Hospital Pharmacy. Each member's subjective professional experiences and their own view of themselves within society were collected through a semi-structured interview. Personal thinking, including experiences, feelings, opinions, desires, and regrets was classified by objective methods, from which main concepts were extracted for the Value Chart. The feedback to the survey, including activities during the Covid-19 pandemic management, is classified according to the analytical methods of Kleinman, Frank, Bury and Launer-Robinson. Regarding sentiment analysis, the emotional and subjective context of the text provides an ideal baseline to validate the result. The analysis was implemented using neural networks trained on dictionaries and natural language (i.e., Tweets). The originality of the work lies in the fact that generally value charters are built on a Society's values. In contrast, in this case, individual contributions were gathered to complement the ethical values on which the society is founded. © 2022 IEEE.
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Since its debut, Mary Shelley's Frankenstein has, fittingly, assumed a life of its own. In today's cultural landscape, the mere mention of 'mutant' evokes the language of Othering, including Frankensteinian metaphors, such as those used to describe the omicron variant of SARS-CoV-2. When scientists referred to omicron as a Frankenstein variant, they demonstrated the inherent mutability of the myth-a myth that is crucial in biomedicine. In this article, the authors examine the shifting nature of Frankenstein metaphors and consider how they function in what Priscilla Wald refers to as outbreak narratives in the context of the USA's COVID-19 policies. The authors point to the ready instatement of travel bans as evidence of how such a potent myth is used to create and sell public policy. In response to such xenophobic policies, the authors apply Donna Haraway's concept of 'boundary breakdowns' in order to reimagine relationships with mutancy. They examine how moving past the idea of mutant is other in contemporary virus narratives may offer a way to reconfigure our relationships of self and other and move beyond the hegemonic and nativist policies of the present.
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COVID-19 , Medicine in Literature , Humans , Metaphor , SARS-CoV-2ABSTRACT
This 21st-Century Psychiatrist column reflects the authors' perceptions of the importance of addressing patient-centered care through mindful listening and mentalizing in psychiatry. The authors maintain that adopting a mentalizing stance is a promising approach for clinicians with diverse backgrounds to humanize clinical practice, especially in today's dynamic high-speed, high-paced, and high-technology environment. Mindful listening and mentalizing are particularly consequential for the field of psychiatry since the COVID-19 pandemic prompted an abrupt transition from in-person to virtual platforms for education and clinical care.
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Objective: Evaluation of the practical effectiveness of a Narrative Medicine (MN)-based intervention on adaptive capacity and relapse prevention in patients with severe mental illness (SMIs) residing in a protected community during the Pandemic due to Covid 19. Method: During the second lockdown, in a residential community with 20 subjects all suffering from SIMs, a group of 6 patients was included in an experimental protocol designed on the principles of MN and compared in parallel with a control group of the same number of patients. The clinical evolution was measured with standardized assessment tools (GAF;CGI;BPRS;MMSE;EuroQoL) together with a nonstandardized qualitative methodology. The total duration of the study was 16 weeks. Results: At the end of the study there was a significant improvement in the score of CGI, GAF, BPRS and in particular, about the latter, in the dimensions of: feelings of guilt, suspiciousness, hostility, affective flattening. On a qualitative level, there was a parallel improvement in the ability to express and recognize emotions with favorable effects on relationships. At the same time, a greater satisfaction of the operators was appreciated. There were no relapses and no need for hospitalization or changes in ongoing therapy. Conclusions: Our experience has shown that during the stressful event of the pandemic, rather than foreseeable relapses, the MN approach has led to an improvement of the clinical picture not only in the patients of the study, but also, albeit to a lesser extent, in the other guests of the community. At the same time, increased satisfaction of the operators was appreciated. The integration between EBM-based clinical practice and MN appears to be a promising field of research for further studies on patients with SMIs in residential care regarding appropriateness of interventions, quality of treatments, cost-effectiveness and optimization of resources. (PsycInfo Database Record (c) 2023 APA, all rights reserved) (Italian) Oggetto: Valutazione dell'efficacia pratica di un intervento basato sulla Medicina Narrativa (MN) su capacita di adattamento e prevenzione delle ricadute in Pazienti affetti da Malattia Mentale Severa (SMIs) residenti in una comunita protetta durante la Pandemia dovuta a Covid 19 Metodo: Durante il secondo lockdown, in una comunita residenziale con 20 soggetti tutti affetti da SIMs, un gruppo di 6 pazienti e stato inserito in un protocollo sperimentale progettato sui principi della MN e confrontato parallelamente a un gruppo di controllo di altrettanti pazienti. L'evoluzione clinica e stata misurata con strumenti di valutazione standardizzati (GAF;CGI;BPRS;MMSE;EuroQoL) congiuntamente a una metodologia qualitativa non standardizzata. La durata complessiva dello studio e stata di 16 settimane. Risultati: A conclusione dello studio si e osservato un significativo miglioramento del punteggio di CGI;GAF;BPRS e in particolare, circa quest'ultima, nelle dimensioni di: sentimenti di colpa, sospettosita, ostilita, appiattimento affettivo. Sul piano qualitativo si riscontrava un miglioramento parallelo della capacita di esprimere e riconoscere le emozioni con ricadute favorevoli sulle relazioni. Congiuntamente si e apprezzata una maggiore soddisfazione degli operatori. Non si sono verificate ricadute e non sono stati necessari ricoveri o variazioni delle terapie in corso. Conclusioni: Dalla nostra esperienza e risultato che durante l'evento stressante della pandemia, piuttosto che prevedibili riacutizzazioni, attraverso l'approccio basato sulla MN si e ottenuto un miglioramento del quadro clinico non solo nei pazienti dello studio, ma di riflesso, seppure in minor misura, anche negli altri ospiti della comunita. Contestualmente si e apprezzata una maggiore soddisfazione degli operatori. L'integrazione tra pratica clinica basata sulla EBM a MN appare un promettente campo di ricerca per ulteriori studi su Pazienti con SMIs in assistenza residenziale riguardo appropriatezza degli interventi, qualita dei trattamenti, economicita e ottimizzazione delle risorse. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
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This research focuses beyond the doors of an open ICU: a hospital ward with a high degree of complexity and organizational innovation in which the most recent events in the health emergency from COVID-19 pose new difficulties and unprecedented challenges. First of all, the scope of application of the Patient Diary tool is defined starting from the reference literature up to its introduction in the Neuroreanimation department of the AOUC, Florence (Italy). The Di.Te. project's main numbers and the qualitative study's main themes are presented. Finally, a summary reflection on the patient's diary is proposed as a channel for dialogue between all the interacting actors in the ward and as a tool for co-constructing the treatment path. © FrancoAngeli.
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Contrasting COVID-19 is widely debated but often treated from a clinical or, at most, managerial perspective. Less attention is instead assigned to a narrative view of the problem. However, the stories of those who combat this pathogen teach us the need to use storytelling strategies to counteract the effects of the disease on patients and its consequences on healthcare providers. This contribution aims to address the COVID-19 issue from the perspective of narrative medicine, first by defining it and then by reporting some healthcare professionals' experiences. It intends to highlight the importance that medicine has not only on the patient but also on healthcare professionals. It offers a brief review of some of their narratives, focusing on experiences with different tones and struggles and emphasizing the importance of narrative in one's work in supporting patients. In addition, this contribution also aims to reason that not everything can be solved with words, as they help but do not solve everyday problems.
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Background: COVID-19 pandemic disturbed mental health of healthcare personnel. Residents of the specialization programs could be at risk, since they were reassigned in their functions. Aim: To describe the impact of COVID-19 pandemic on symptoms of depression, stress, anxiety and resilient coping in residents of Anesthesiology, Internal Medicine and Emergency Medicine Material and Methods: Residents were invited to answer an online survey containing the DASS-21 scale for anxiety, stress and depression symptoms and the Brief Resilient Coping Scale (BRCS) for resilience skills. Results: Fifty four out of 90 residents answered the survey. Eighteen to 24% of respondents had symptoms of depression, anxiety and stress at severe and extremely severe levels. Those with severe and extremely severe symptoms had also the lowest score on the BRCS resilience scale. We did not find an association between severity of symptoms and gender. Discussion: A proportion of respondent residents had severe psychological symptoms and lower resilience scores during the COVID-19 pandemic.
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Outcomes: 1. Explore the ways that palliative and mental health providers can collaborate to offer a novel, interdisciplinary wellness curriculum. 2. Evaluate impacts of a wellness course on secondary trauma, self-compassion, and burnout. Background(s): Palliative care and mental health providers possess skill sets that, when combined, can uniquely foster the well-being of colleagues within and beyond our specialties. The need for such peer support has become more urgent during the COVID pandemic. Self-care, compassion satisfaction, and trauma-informed training have been positively associated with an ability to cope with stressors in healthcare. We designed a 2-week GME elective intended to increase self-compassion and connection and reduce secondary trauma and burnout. Description: The course has been offered annually since 2019 to cohorts of 12-15 trainees across 14 specialties. Trainees participated in-person (2019, 2021) and virtually (2020). Coursework includes psychological safety, burnout/suicide prevention, self-compassion, occupational trauma and recovery, expressive art, medical error, cultural humility/upstanding, narrative medicine, conflict resolution, mindfulness, and others. We sought to evaluate the impact of the elective on burnout, self-compassion, and secondary trauma using the Professional Quality of Life (PROQOL) survey in the 2021 cohort. We evaluated trainee satisfaction with the course in all three cohorts (2019-2021). Result(s): 1 month after the elective, trainees reported a reduction in secondary trauma (p<0.0001) and an increase in self-compassion (p<0.005). The effect on burnout was not significant (p=0.57). Over 3 years, 100% of trainees (n=43) strongly agreed that the course was worth their time. Participants reported the course gave them "skills to better tolerate distress about things I cannot change" as well as self-agency through connection: "My peers helped me find new power that I didn't know I had." Conclusion(s): We generated a curriculum that impacted self-compassion and secondary trauma. We did not see an effect on burnout, which could be related to returning to an unchanged stressful environment following the course. Expanding access to this curriculum would afford opportunities to assess impact on a larger scale.Copyright © 2023
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AIMS: To: (1) measure the impact of a narrative medicine intervention on compassion fatigue and compassion satisfaction of nurses, midwives and allied health professionals; (2) explore participants' working experiences and (3) their impressions of the intervention. DESIGN: Multi-methods, quasi-experimental before-after intervention design. METHODS: The intervention consisted of 20 narrative medicine sessions (60 h). Healthcare providers (N = 48) from a mother-and-child hospital in Italy completed the 'Professional quality of life' questionnaire before and after the intervention (January 2020-April 2021). Baseline scores served as internal controls. Open-ended questions explored participants' touching experiences at work and their evaluation of the intervention. A thematic content analysis was performed. Reporting followed the TREND and SRQR guidelines. RESULTS: The differences before-after intervention in compassion satisfaction or fatigue scores were not statistically significant. Three themes emerged from participants' touching experiences: "Witnessing death and sufferance"; "Witnessing violence" and "Organizational stressors during COVID-19". A statistically significantly higher median score for post-intervention compassion satisfaction was found among participants who reported at least one touching experience compared to those who had no touching experience. Four themes emerged from the reported strengths of the program: "Learning to exteriorize feelings"; "Team building"; "Useful to rework personal/professional journey" and "Develops professional empowerment". Two themes emerged from reported weaknesses: "Programme organization" and "Participants' difficulties in sharing experiences". CONCLUSION: A time-limited narrative medicine intervention is not sufficient to produce significant changes in satisfaction or compassion fatigue, especially if implemented during a pandemic. However, such an intervention holds promise for supporting nurses and midwives' professional empowerment and promoting continuity of compassionate care. IMPACT: For those at risk of compassion fatigue, policymakers need to invest in training in narrative medicine, which promotes team building, and employee well-being and thus favours compassionate care. Such programmes should be offered to undergraduate students to nurture compassion and attention to self. PATIENT OR PUBLIC CONTRIBUTION: Does not apply as the study only includes health care providers.
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Filipinos are often reluctant to seek professional mental health (MH) help. However, literature reveals that online counselling is preferable to face‐to‐face (F2F) MH services, with the pandemic possibly magnifying technology's anonymity and disinhibiting benefits. To further explore facilitators of online MH help‐seeking, this study tapped into the lived stories of Filipino adults who experienced at least one counselling session from March 2020 to March 2022. Among 83 screened respondents, 11 semistructured interviews were transcribed and analysed following Crossley's (2000) method. Findings reveal an overarching online MH counselling narrative composed of three phases and their respective events: (a) Precounselling (Resiliency Narrative versus MH Awareness, Turning Point, and Linking versus Searching);(b) Counselling (Two‐way Introduction, Unloading and Untangling, and Decision to Maintain or Terminate);and (c) Postcounselling (Relapse and Journey towards Growth and Advocacy). Three all‐encompassing facilitators were embedded throughout the process: Autonomy, Financial Capability, and MH Institutions. Notably, participants attributed their MH help‐seeking to autonomy, despite culture and stigma, because of enabling environments that entail heightened MH literacy, positive past experiences with professional MH help, social support and encouragement, and a sense of shared reality. Benefits unique to online counselling were also apparent among participants' narratives, including alleviating geographical boundaries and added financial and personal pressures. Overall, findings posit that Filipino adults consider online counselling as a preferable alternative to F2F counselling, thus necessitating further development and institutional support. [ FROM AUTHOR]
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Background: After Covid-19 emergency, operators always had to work with approved and safe Personal Protective Equipment (PPE) for patients and professionals, but which limited communication, the approach to assistance and the helping relationship. Those who practice professional health care practices as they are exposed to the suffering of others should be aware of the need for themselves to equip themselves adequately to face difficult situations through suitable narrative practices of selfcare. This study has a dual purpose: to investigate the experience of the health care personnel of the Piacenza's Oncology Department through narrative medicine following the use of PPE and to help operators become aware of it through creative writing. Material(s) and Method(s): We conducted a qualitative study, the data collection tool is creative writing, consisting of write unconditionally by first reading a preface consisting of sequential questions. The sample selection has been voluntary based subject to prior informed consent signature. 14 texts writed by nurses and oss were collected. The data analysis took place with analysis of the thematic content. Qualitative analysis involves the fragmentation of data into simpler units and the subsequent recomposition in new ways. Result(s): The results of creative writing were divided into four macrocodes: PPE Data Changes, Strategies, PPE Negative Side, PPE Positive Side, in turn divided into several microcodes. Emerge the difficulties of the health care personnel in using PPE in the care approach and the strategies that were introduced in the face of these difficulties. Conclusion(s): From the analysis emerged all the changes that the PPE have involved: the impossibility of approaching, seeing and touching each other, in particular not being able to show the face and to be recognized and to smile. Through examples of everyday life, the disadvantages of the use of PPE have been highlighted but at the same time it is evident that the use of protective devices has made it possible to re-elaborate the approach to the patient, reminding professionals of the need for empathy and listening, devising creative ways to deal with these difficulties such as the use of video calls, gazes. They noticed a greater humanization thanks to the use of PPE: less abrupt and frenetic ways have been introduced during the satisfaction of needs and a greater willingness to stay "here and now" in the care relationship to limit the shortcomings.
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Narrative medicine is an interdisciplinary field that complements and expands on conventional healthcare training by supporting narrative competence skills and creativity derived from the arts and humanities domains to address the needs of healthcare providers and receivers. With the COVID-19 pandemic having had a profound impact on the healthcare workforce with an already high burn-out rate, multimodal arts interventions may help address the holistic dimensions of well-being. While empirical evidence supports the use of arts-based interventions in promoting healthcare workers' well-being and personal growth, art prompts are underexplored and underused in narrative medicine. Moreover, protocols and frameworks adopted in extant research on this topic are inconsistent, resulting in replication and validation challenges. These issues have motivated this exploratory-descriptive study with 11 narrative medicine practitioners to examine the use of short art prompts in an online narrative medicine workshop.The art prompts leveraged art therapy's Expressive Therapies Continuum (ETC) model, which uses the inherent properties of art materials, media and methods to elicit specific levels of information processing and creative experiences. The study aimed to understand how art prompts differ from writing prompts and explore the value art prompts could add to narrative medicine if any. Qualitative analyses revealed that art prompts in narrative medicine increase positive feelings and promote creativity and insight. Specifically, art prompts allowed participants to use sensorimotor functions, enter a flow-like state, be challenged and inspired by novelty and uncertainty, and experience a sense of play and personal discovery.
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Fifty-five patients who suffered from COVID-19, who were still very ill after several months, with extreme fatigue, effort exhaustion, brain fog, anomia, memory disorder, anosmia, dysgeusia, and other multi-systemic health problems have been followed in a family practice setting between May 2021 and July 2022. Data extracted from the medical records of the 55 patients (40 women), mean age 42.4 (12 to 79 years), and a qualitative study of 6 of them using a semi-open-ended questionnaire allowed to highlight the clinical picture described by WHO as post-acute COVID-19 syndrome (PACS) also known as long COVID. We used brain single-photon emission computed tomography (SPECT-CT) in thirty-two patients with a high severity index and a highly impaired functional status, demonstrating vascular encephalopathy in twenty nine patients and supporting the hypothesis of a persistent cerebral vascular flow disorder in post COVID-19 condition. The patients will benefit from the consortium COVID Human Genetic Effort (covidhge.com) to explore the genetic and immunological basis of their problem, as 23/55 cases don't have immunological certainty of a COVID-19 infection. There is no known verified treatment. Analyzing the data from the first 52 patients, three categories of patients emerged over time: 16 patients made a full recovery after 6-8 months, 15 patients were able to return to life and work after 12-18 months with some sequelae, both groups being considered cured. In the third group, 21 patients are still very ill and unable to resume their work and life after 18 months. The biopsychosocial consequences on patients' lives are severe and family doctors are left out in the cold. It is necessary to test the reproducibility of this description, conducted on a small number of patients. Nevertheless, identifying, monitoring and supporting these patients is a necessity in family medicine.
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COVID-19 , Adult , Belgium/epidemiology , COVID-19/complications , Family Practice , Female , Follow-Up Studies , Humans , Reproducibility of Results , SARS-CoV-2 , Treatment Outcome , Post-Acute COVID-19 SyndromeABSTRACT
Through an adequate survey of the history of the disease, Narrative Medicine (NM) aims to allow the definition and implementation of an effective, appropriate, and shared treatment path. In the present study different topic modeling techniques are compared, as Latent Dirichlet Allocation (LDA) and topic modeling based on BERT transformer, to extract meaningful insights in the Italian narration of COVID-19 pandemic. In particular, the main focus was the characterization of Post-acute Sequelae of COVID-19, (i.e., PASC) writings as opposed to writings by health professionals and general reflections on COVID-19, (i.e., non-PASC) writings, modeled as a semi-supervised task. The results show that the BERTopic-based approach outperforms the LDA-base approach by grouping in the same cluster the 97.26% of analyzed documents, and reaching an overall accuracy of 91.97%.
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Background: COVID-19 resulted in sudden interruptions to medical education, including challenges to delivering global health (GH) experiences. Narrative medicine (NM), which emphasizes literary perspective and uncertainty within healthcare, may be a tool to increase physician resilience. GH and NM perspectives both have potential to augment resident education during the unprecedented disruption of COVID-19. Our objective is to describe a new curriculum incorporating NM and topics in GH disparities for pediatric interns. Methods: For the academic year 2020-21, a curriculum focused on disparities in global maternal child health (MCH) coupled with a practicebased introduction to NM was developed and piloted for pediatric interns at a single pediatric residency program during their month-long advocacy rotation. Two weeks prior to the session, interns received 2 MCH articles and 2 narrative fictional pieces with themes relevant to MCH. During a single 90-minute session, global and local disparities in MCH were reviewed, with focus on synthesis of primary data sources. An introduction to the history of NM was provided along with guided discussion of the fictional pieces. Time was provided for independent writing, with the option for interns to share their pieces. Results: Interns were sent pre-/post-surveys focused on prior experience with NM and GH;no questions about probing resident resilience were included. All 26 interns participated in the session during the academic year, with pre-survey results from 26 and post-survey results from 17. A majority had previous didactic GH learning;while a majority knew of NM as a discipline (N = 19), fewer (N = 9) had participated in any NM experience (Figure 1). Post-session data are presented in Figure 1 and Table 1. The session was wellreceived with high interest in further GH and NM content during residency. Conclusion: The addition of a joint GH and NM session to an existing pediatric resident advocacy curriculum during COVID-19 provides both foundational knowledge in GH disparities and opportunity for self-reflection during uncertain times. To our knowledge, this is the first description of such a curriculum that incorporates these two disciplines. Preliminary evaluation indicates increased knowledge and awareness of narrative medicine after the session, with majority desire for further NM and GH education during residency training. Further evaluation will consider the role of NM in increasing pediatric resident resilience and in improving self-efficacy in advocacy.
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To use narrative medicine as a means for action towards social justice in medical education, we need a renewal of our pedagogical methods that grapples not just with the worlds concocted within a text, but also our own world beyond the text. We propose a model for narrative medicine pedagogy that is oriented towards abolition. First, the composition of the classroom and syllabus must employ radical inclusion through recruitment of diverse voices and selection of diverse texts. After a traditional close reading is initiated, conscious expansion should take place through introduction of a text's context and current social structures. Whenever internal and external conflicts arise, active self-interrogation should be encouraged through José Esteban Muñoz's 'disidentification'.We present relevant critiques of narrative medicine, case studies from workshop experiences, and close readings of selected narrative medicine texts to unmask limitations in the standard narrative medicine workshop format and illustrate the utility of our abolitionist model. The model we propose offers methods for disrupting long-standing patterns of inclusion (and exclusion) and radically transforming the structure of spaces and ideas produced within them. When new texts are added to the syllabus, they should be accompanied by hermeneutics that can adequately attend to them. Abolitionist narrative medicine pedagogy should stimulate practitioners to examine their own role in social structures that surround the text and the setting of close reading and, ultimately, to dismantle harmful structures. We offer strategies for confronting discomfort without requiring an abandonment of identity, context or content. Instead, holding complexity works towards the long-term aim of transforming practitioners to think critically about structural violence that prevents universal and equitable access to compassionate healthcare. Using this model for abolition, we hope practitioners of narrative medicine will be equipped with more dynamic tools to engage with texts and patients within and beyond the scope of the narrative medicine workshop.
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Education, Medical , Narrative Medicine , Humans , NarrationABSTRACT
SETTING AND PARTICIPANTS: The initial narrative medicine sessions were held virtually over Zoom during the 2020-2021 academic year due to COVID-19. Sessions were held in person during the 2021-2022 academic year. Each session included 8-16 internal medicine residents. Residents participated in a single session during their ambulatory block. DESCRIPTION: Narrative medicine has been integrated into medical training with increased depth and frequency to enhance competencies such as observation, reflection, and self-care among trainees. The narrative medicine sessions in this pilot curriculum consisted of one-hour interactive workshops. The workshops began with a brief introduction to the field of narrative medicine, followed by a discussion of a short literary text. After reading and discussing the text, participants were asked to complete a brief writing exercise designed to elicit a personal narrative, and responses were then shared with the larger group. EVALUATION: Following the workshop, participants (N=100) completed a retrospective pre- and post- survey assessing the impacts of this intervention on several different variables. Descriptive statistics were used to evaluate pre- and post-workshop differences. Participants also completed open-ended questions assessing what they learned from the session and what they could apply to their future practice, and key themes were extracted. The survey was administered through a HIPAA-compliant online platform, and no personally identifiable data were collected. Participants' interest in learning about the field of narrative medicine increased significantly after the workshop compared to prior (p<0.01). After the workshop, participants noted significantly higher levels of confidence in their ability to listen to patient stories, analyze short pieces of literature, and engage in reflective writing (p<0.01). They also expressed significantly greater agreement with the notions that engaging in literary analysis and reflective writing could improve patient care, reduce provider burnout, and improve connectedness to one's colleagues (p<0.01). Analysis of open-ended questions demonstrated that participants found the sessions to be engaging and worthwhile, and that many skills could be applied to their future practice. DISCUSSION / REFLECTION / LESSONS LEARNED: The results of this pilot study suggest that incorporating a brief narrative medicine curriculum into an internal medicine residency program is both feasible and valuable. A single, one-hour session was easily integrated into a pre-existing ambulatory block;participation fostered meaningful reflection, development of observational skills, and connection with colleagues. The session was positively received, and participants were able to appreciate the ways in which narrative medicine could enhance their own medical practice. Future directions include expanding the curriculum over all 3 years of residency and integrating it into existing curricula that address issues such as Social Determinants of Health and Equality, Diversity, and Inclusion.
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BACKGROUND: NarrativeMedicine (NM) is a novel activity shown to have positive effects on emotional and professional development. It has been shown to combat burnout in learners by providing the opportunity for reflection and normalization of traumatic experiences during training. In this study, a NM curriculum was introduced into the Internal Medicine-Primary Care residency at Penn to study its effects on resident wellbeing, professional development, and social connectedness. In response to current events, sessions were catered toward processing COVID, acknowledging healthcare and racial disparities within the pandemic, and amplifying voices of female authors and authors of color. METHODS: Primary care residents participated in a total of 3-5 one-hour NM sessions during protected didactic time from 2021-2022. Sessions were conducted over Zoom and facilitated by a project leader. Each session had a distinct theme including 1) working during a pandemic, 2) compassion fatigue, 3) finding meaning in work, 4) burnout, and 5) pandemic lessons learned. For each session literary excerpts or videos were read/viewed together, followed by a writing/reflective activity, and concluding with group discussion. After each session, residents were given a link to an optional, anonymous online survey to evaluate professional development, personal growth, utility of each component of the session and overall rating. The survey was conducted using a Likert sale of (1) negative or not useful to (5) greatly positive or extremely useful, and open-response questions evaluating the objectives of and reaction to the curriculum. RESULTS: 5-10 residents attended each session resulting in 28 survey responses to date, with 4 sessions (2 themes) yet to be completed. Most residents preferred group discussion to individual writing or reflection. Connectedness with co-residents showed the strongest professional development rating (mean 4.6/5), versus slightly positive benefit toward impact on patient care (3.8). Regarding personal growth, sessions were rated as highly enjoyable and personally valuable (4.7) with positive impact on wellness (3.9), job satisfaction (3.7) and appreciation of work values (3.9). Regardless of distinct benefits, sessions were highly rated for “overall impression” (4.8). This mirrors open responses, which overwhelmingly describe a positive space for necessary reflection and processing. CONCLUSIONS: Our study suggests that shared discussion and storytelling were the most valuable components of NM sessions, providing an impactful experience that improves resident comradery and personal/professional growth.
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SETTING AND PARTICIPANTS: The COVID 19 pandemic has reshaped how we approach medical education. A need to care for the surge of hospitalized patients and abide by social distancing guidelines to protect our workforce have both limited the time and ability to hold traditional in person teaching sessions. In addition, a focus on caring for these critical sick patients has taken the focus away from chronic disease management and primary care in general. In the setting of the above stressors, increasing physician and resident burnout have affected mental wellbeing and limited our band-width to partake in nonrequired learning. Our internal medicine program had our inaugural primary care workshop in March of 2021. We had to modify our curriculum significantly in order to fit within institutional social distancing policies and ensure the safety of all participants. The workshop was designed for eleven internal medicine resident in our primary care track at a mid-sized IM program. DESCRIPTION: Using a combination of virtual and in-person sessions, we were able to cover a variety of primary care topics and provide an opportunity for comradery and reflection for our primary care track residents during this single day event. The morning was a completely virtual session over the Webex platform that included an initial icebreaker/narrative medicine exercise. This was followed by an advocacy panel discussion and an update on the state of immigrant health in Oregon. The afternoon was an in-person event in a large room that allowed for adequate social distancing. It included an outpatient injection and ultrasound practice session followed by a two hour introduction to Medical Improve. We concluded the day with a Nexplanon training and certification session. EVALUATION: On a post-course survey using Likert scales ranging from 1 to 5 (1=not well at all and 5=extremely well) residents reported the workshop increased the sense of a primary care community within the residency program (mean 4.7, SD 0.45), expanded general knowledge in primary care (mean 4.6, SD 0.48), and increased understanding of varied career paths with in the field (mean 4.3 SD 0.75). All residents reported the workshop made them feel more excited about primary care. DISCUSSION / REFLECTION / LESSONS LEARNED: We believe the ingredients that led to a successful workshop included time for reflection and sharing of experiences, hands-on skills practice, mini-lectures in areas in which our residents had requested further training, and team building through a Medical Improv course. Through organizing the workshop, we have identified the importance of obtaining program support early on in the process and finding the right mix between virtual and face-to-face sessions. We believe surveying current residents and alumni was crucial to determining our agenda and invited speakers. In addition to specific lectures, it is imperative to include activities that foster engagement and community building during workshops, especially during a time in which it has been challenging to build relationships.