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Cattaneo RA, González N, Leafe A, Fleishman R. Pediatric Resident Perceptions of a Narrative Medicine Curriculum. THE JOURNAL OF MEDICAL HUMANITIES 2024; 45:157-169. [PMID: 38051391 DOI: 10.1007/s10912-023-09817-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 12/07/2023]
Abstract
Training residents to become humanistic physicians capable of empathy, compassionate communication, and holistic patient care is among our most important tasks as physician educators. Narrative medicine aims to foster those highly desirable characteristics, and previous studies have shown it to be successful in fostering self-reflection, emotional processing, and preventing burnout. We aimed to evaluate pediatric residents' perceptions of a novel narrative medicine curriculum. After the initiation of a longitudinal narrative medicine curriculum, focus groups were conducted with residents who participated in at least one narrative medicine session. The curriculum was viewed positively, and residents found the sessions to be helpful in developing empathy, offering a space for reflection, and introducing new perspectives. Challenges noted were perception of relevance, timing of sessions, and interpretation by non-native English-speaking residents. With attention to linguistics and thematic undertones, narrative medicine is a feasible, replicable, and accepted teaching modality for pediatric residents to foster empathy, process emotions, and participate in self-reflection.
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Affiliation(s)
- Raymond A Cattaneo
- Department of Pediatric and Adolescent Medicine, Jefferson Einstein Hospital, 5501 Old York Road, Philadelphia, PA, 19141, USA
| | - Natalie González
- Department of Pediatric and Adolescent Medicine, Jefferson Einstein Hospital, 5501 Old York Road, Philadelphia, PA, 19141, USA
| | - Abby Leafe
- New Leafe Research, 103 Hillborn Drive, Newtown, PA, 18940, USA
| | - Rachel Fleishman
- Department of Pediatric and Adolescent Medicine, Jefferson Einstein Hospital, 5501 Old York Road, Philadelphia, PA, 19141, USA.
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Tsevat RK, Young P, Zhang E, Baugh S, Pessegueiro AM. Implementation and Evaluation of a Pilot Narrative Medicine Curriculum for Internal Medicine Residents. Cureus 2024; 16:e53396. [PMID: 38435135 PMCID: PMC10908347 DOI: 10.7759/cureus.53396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 01/22/2024] [Indexed: 03/05/2024] Open
Abstract
Background Narrative medicine has been integrated into medical training to enhance competencies such as observation, reflection, and self-care. However, few studies have assessed the impact of a single narrative medicine session using a pre- and post-test study design. The authors of this study sought to implement a pilot narrative medicine curriculum into a large internal medicine residency program and to evaluate its feasibility and impact. Methodology The curriculum consisted of a one-hour reading and writing workshop held during ambulatory academic half-days from 2021 to 2022. Resident participants completed a retrospective pre- and post-workshop survey evaluating their interest and confidence in practicing narrative medicine skills, as well as their beliefs about the impacts of narrative medicine on patient care and provider well-being. Descriptive statistics evaluated pre- and post-workshop differences using the Wilcoxon signed-rank test. Subgroup analyses were conducted based on postgraduate year, residency track, and workshop setting. Additionally, participants completed open-ended questions that were analyzed qualitatively. Results Of 218 resident participants, 152 (69.7%) completed the post-session survey. Participants noted significantly higher levels of confidence and interest in listening to patient stories, analyzing literary texts, and engaging in reflective writing after the workshop. They also expressed significantly higher levels of agreement that engaging in literary analysis and reflective writing could improve patient care, reduce provider burnout, and strengthen connectedness with colleagues. Qualitative analysis demonstrated that participants found the sessions to be worthwhile and appreciated how narrative medicine could enhance their medical practice. Conclusions Incorporating a brief narrative medicine curriculum into an internal medicine residency program is both feasible and valuable. A single narrative medicine session was practical and well-received by residents, as it promoted self-reflection, observational skills, and connection with colleagues. Future workshops should be customized for different training levels and residency tracks, and additional studies should evaluate whether the outcomes persist over time.
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Affiliation(s)
- Rebecca K Tsevat
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, USA
- Department of Medicine, Division of Internal Medicine-Pediatrics, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, USA
- National Clinician Scholars Program, University of California, Los Angeles, Los Angeles, USA
| | - Peter Young
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, USA
| | - Eunice Zhang
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, USA
- Department of Medicine, West Los Angeles Veterans Affairs Medical Center, Los Angeles, USA
| | - Samuel Baugh
- Department of Statistics, Penn State University, University Park, USA
- Department of Statistics, University of California, Los Angeles, Los Angeles, USA
| | - Antonio M Pessegueiro
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, USA
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Paul TK, Aglio T, Dalgo A, Kaye EC. Narrative Medicine in Hospice and Palliative Care: A Longitudinal Fellowship Curriculum Pilot. Am J Hosp Palliat Care 2023:10499091231223717. [PMID: 38128066 PMCID: PMC11190033 DOI: 10.1177/10499091231223717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION Growing evidence suggests that clinician exposure to narrative medicine (NM) may help bolster resilience and mitigate burnout. The value of formal longitudinal training in NM for hospice and palliative medicine (HPM) trainees remains understudied. METHODS A 1-year longitudinal NM curriculum for HPM fellows was pilot-tested for feasibility, acceptability, and exploratory impact. Six monthly 45-minute sessions included reading literature, reflective writing, and sharing creative work. Quantitative and qualitative data were collected through a pre-intervention survey and post-intervention survey administered immediately upon completion of the curriculum. Longitudinal impact was assessed with a post-intervention survey administered three months after completion of the curriculum. RESULTS All HPM fellows (n = 6) attended at least 5/6 sessions during the 1-year pilot, suggesting intervention feasibility. Participant engagement and self-reported comfort with NM exercises supported intervention acceptability. Post-intervention, participants described the positive influence of NM practice on their clinical practice and stated an intention to integrate NM skills in their future HPM careers. Three months following the intervention, participants had a sustained increase in their comfort level with NM. All participants felt that the NM sessions had been relevant to their life as HPM fellows and anticipated using NM moving forward in their practice of HPM. DISCUSSION This novel NM curriculum was feasible and acceptable to implement in a 1-year HPM fellowship. Longitudinal impact showed sustained increase in trainee comfort and interest in using NM in their future clinical practice.
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Affiliation(s)
| | - Taylor Aglio
- Connecticut Children’s Medical Center, Hartford, CT, USA
- University of Connecticut School of Medicine, Memphis, TN, USA
| | - Austin Dalgo
- Le Bonheur Children’s Hospital, Memphis, TN, USA
- University of Tennessee Health Sciences Center, Memphis, TN, USA
| | - Erica C. Kaye
- St. Jude Children’s Research Hospital, Memphis, TN, USA
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Historical empathy and medicine: Pathography and empathy in Sophocles’ Philoctetes. MEDICINE, HEALTH CARE AND PHILOSOPHY 2022; 25:561-575. [PMID: 35449242 PMCID: PMC9022738 DOI: 10.1007/s11019-022-10087-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 04/03/2022] [Indexed: 11/24/2022]
Abstract
The aim of this article is to explore the ways in which the engagement with Greek tragedy may contribute fruitfully to the unfolding of empathy in medical students and practitioners. To reappraise the general view that classical texts are remote from modern experience because of the long distance between the era they represent and today, I propose an approach to Greek tragedy viewed through the lens of historical empathy, and of the association between past situations and similar contemporary experiences, in particular. After a brief examination of the concept of empathy, its links with literary reading, and the discussion of these interrelations within the training of narrative medicine, and narrative ethics in particular, the focus turns to selected parts of Sophocles’ Philoctetes, such as the disease scene—an ancient example of pathography. Here Neoptolemus’ empathy for Philoctetes’ situation and its consequences are explored with specific interest in the modern readers’ affective response in connection with their own experiences in medical practice. Neoptolemus’ ethical conflict, which is resolved by his decision to care for Philoctetes, and the problematic nature of this attitude are both indicative of the aim of Greek tragedy to problematize universal issues and thus to point towards the instability of human life and the fluidity of human nature. Realizing through historical empathy the precariousness of human existence may lead to a better understanding and hence better care for others and open new perspectives in the development of empathy within the context of contemporary medical education and practice.
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