Storied reflections: Development of a longitudinal interdisciplinary curriculum to improve patient-provider communication.

Objective: This article details the development of an interdisciplinary graduate medical education (GME) narrative curriculum. Methods: Descriptive statistics were conducted for the narrative session surveys. Two separate qualitative analyses were conducted. First, content and thematic analyses of the open-ended questions in the survey using NVIVO software occurred. Second, an inductive analysis of the participants' 54 stories was performed to identify unique themes not related to the prompt topics. Results: Quantitative survey results demonstrated that 84% of learners' felt the session benefited their personal or professional sense of wellbeing and resilience, 90% of learners believed the sessions aided in their ability to listen more effectively, and 86% of learners could apply what they practiced or witnessed. Qualitative analysis of survey data showed learners focused on patient care and listening. Thematic analysis of participants' narratives revealed strong feelings and emotions, struggles with time management, increase in self- and other-awareness, and challenges managing job-life balance. Conclusion: The longitudinal interdisciplinary Write-Read-Reflect narrative exchange curriculum is cost-effective, sustainable, and demonstrably valuable to learners and their program directors across multiple disciplines. Innovation: The program was designed for 4 graduate programs' learners to simultaneously experience a narrative exchange model to improve patient-provider communication, support professional resilience, and deepen relationship-centered care skills.

A Mixed-Methods Exploration of the Developmental Trajectory of Autonomous Motivation in Graduate Medical Learners.

INTRODUCTION: Self-determination theory (SDT), when applied to curricular construction, emphasizes curiosity, self-awareness, and resilience. Physicians need these qualities to face the challenges of clinical practice. SDT offers a lens for medical educators to track learner development toward sustainable, rewarding careers. This study describes the changes observed in learner communications about feelings of competence, relatedness, and autonomy across a 3-year family medicine training program designed to develop activated, lifelong learners. METHODS: This retrospective, mixed-methods case study uses a phenomenological approach to explore how 51 learners described their experiences at various intervals in residency training. Data collected from 2009 to 2015 from resident focus groups, competency assessment meetings, and faculty assessment reports inform a 3-stage analysis process to determine learner motivation levels along the SDT continuum. RESULTS: Aggregated qualitative and quantitative data show residents' progression from introjection (controlled motivation) in PGY1, to identification (autonomous motivation) in PGY2, and integration (autonomous) by the end of PGY3. The examination of a single learner's data set reveals an advanced motivation level in PGY1 (identification), followed by a period of retrograde in PGY2 (introjection), then rebounding in PGY3 (identification), which illustrates how motivation level can be affected by external competency requirements and challenges related to career transitions. DISCUSSION: The examination of self-motivation in medical learners has implications for curriculum development, assessment, teaching and self-directed learning, and resilience training. Learner awareness of intrinsic motivation, and the curriculum designed around it, can better prepare residents for challenges during residency and help them flourish in twenty-first-century medicine.

An Autoethnographic Examination of Postpartum Depression.

PURPOSE: This article examines postpartum depression (PPD) using autoethnography to explore the stigmatization of depression and cultural expectations of motherhood. Because the personal experiences of living with PPD are often absent from primary care literature, this article uses first-person narrative and analysis of intensive mothering to explore the barriers to seeking PPD treatment, the need for increasing physician confidence and comfort using screening tools, and the impact PPD stigma has on patients and their health care. METHODS: Autoethnography, as a relatively unfamiliar methodology in primary care, is used to illuminate individual experiences of living with PPD. The author details a series of encounters as wife, mother, and patient by narrating what it means to live with the disease. A thematic analysis of the series of first-person narratives was employed to further understand the culture of motherhood and shed light on the stigmatization of PPD. RESULTS: Four themes emerged from the analysis revealing the pressures surrounding the cultural ideologies of intensive mothering and the stigma of mental illness: essentialism, failure, shame, and avoidance. DISCUSSION: There is a need to reframe cultural perceptions of motherhood and PPD to positively impact familial interactions and health care encounters for those who live with the illness. The article calls for providing broader diagnostic efforts, more comprehensive care, and engagement with patients in shared decision making around the diagnosis and treatment of PPD.

The outcome of interprofessional education: Integrating communication studies into a standardized patient experience for advanced practice nursing students.

The purpose of this qualitative study was to examine the impact of standardized patient experiences (SPE) in the education of the Advanced Practice Nurse (APN). The education of the APN requires educators to make every attempt to promote competency in the areas of communication and clinical-decision making. SPE programs have been found to improve the interpersonal, problem solving, and critical thinking skills of nursing students. For this research twenty-nine APN students participated in SPEs over the course of two semesters. Fifteen student volunteers of those 29 participants were then interviewed three months after the experience. Results revealed that having an expert in the field of communication studies increased awareness of communication skills and how to improve nurse-patient encounters in the clinical setting. The interprofessional collaboration during the SPEs assisted in facilitating the application of learned communication skills into patient-centered care of the APN student.

Revealing and concealing Ill identity: a performance narrative of IBD disclosure.

Revealing a hidden, chronic illness is a risky and vulnerable act. Ill individuals often remain socially stigmatized, and those who live with invisible illness must legitimize their ill identity since they infrequently look sick. For individuals with inflammatory bowel disease (IBD), disclosing one's illness carries unique challenges because of the grotesque and taboo nature of the disease. To this end, the bathroom or "water closet" is more than a functional place-it is a space to hide one's ill identity. For many, the point of departure from safety to vulnerability occurs when there is a desire to disclose. In this descriptive essay, revelation of an invisible illness, IBD, and disclosure to others are explored as embodied and situated communication. Through performance narrative, the author shares stories of her disclosive moments to inform others about IBD, explores how the water closet can be a metaphoric boundary, examines various strategies used in revealing hidden illness, and offers possible implications for IBD disclosure to the self and relationships with others.