Making space for stories: promoting physician and medical student well-being through successful medical education storytelling events

Storytelling events in medical education settings are a powerful way to share stories, build community, promote resilience, and foster well-being, but many educators are unsure how to go about creating an event. This paper outlines practical tips to empower readers to plan and carry out a successful, impactful storytelling event.

Examining how a documentary film can serve as an intervention to shift attitudes and behaviours around sexism in STEM

"Picture a Scientist," a documentary featuring stories and research about bias in STEM, reached a large international audience. Yet, the extent to which this type of engaging media can impact gender bias remains unclear. In a unique collaboration between film creators and researchers, the current large-scale field studies explored whether "Picture a Scientist" functioned as an intervention and persuasive message targeting sexism in STEM. Study 1 found viewers who indicated more knowledge and stronger emotions, perspective-taking, and transportation after the film were more inspired to continue learning sexism in STEM and combating unfair treatment, suggesting the documentary engaged both classic and narrative persuasion processes. Employing a quasi-experimental design, Study 2 demonstrated that compared to those who had not watched the film (but intended to), participants who had viewed the film indicated higher awareness of gender bias, stronger intentions to address this bias, and participants in leadership reported stronger intentions to enact inclusive policies (for example, making it easier to report mistreatment). Our findings suggest that the use of this documentary may be a relatively low-cost and easily scalable online intervention, particularly when organizations lack resources for in-person workshops. These studies can help inform organizational trainings using this or similar documentaries.

Fictitious cases as a methodology to discuss sensitive health topics in focus groups

PURPOSE

It can be challenging to research aspects of people's health behaviour, attitudes, and emotions due to the sensitive nature of these topics. We aimed to develop a novel methodology for discussing sensitive health topics, and explore the effectiveness in focus groups using prostate cancer and screening as an example.

METHOD

We developed a fictitious case and employed it as a projective technique in focus groups on prostate cancer and screening. The participants were men and their partners who lived in Denmark.

RESULTS

The technique encouraged emotional and cognitive openness in focus group discussions about the risk of prostate cancer, the benefits and harms of screening, and decision-making about screening. It appeared that using the fictitious case allowed the participants to personally distance themselves from the topic, project emotions onto the case, and thereby openly talk about their emotions.

CONCLUSION

This article presents a methodological contribution to communication about sensitive topics in focus groups, using prostate cancer screening as an example. Further refinement of the methodology is needed to enable participants to transfer improvements in knowledge to their own decision about screening.

Addressing racial misinformation at school: a psycho-social intervention aimed at reducing ethnic moral disengagement in adolescents

The present study aims to examine whether by promoting the socio-analytic thinking it is possible to intervene in the reliance on ethnic moral disengagement as a negative consequence of racial misleading news, that can seriously contribute to the diffusion of ethnic prejudice. We focus on the neglected phenomenon of racial hoaxes, which can be defined as misleading news stories dealing with health or safety threats, in which the protagonist is described in terms of ethnicity or nationality. The intervention procedure has been created starting from the well-established literature focused on media biases’ reflection, integrated with the recent studies on ‘mediated intergroup contact’ where the observation of the person belonging to the outgroup is crucial for prejudice reduction. The intervention involved 83 adolescents (Mage = 13.9; SDage = 0.9) and it was composed of two different parts, one focused on the analytical racial hoax reading, and the other focused on racial hoax rewriting after the ‘mediated contact’, represented by an alternative story given by the African protagonist. The results show that in dealing with misleading news, the promotion of this social-analytic processing reduces ethnic biases of moral disengagement. In particular, it was found that analytical processes are supported by the participants’ level of propensity for analytical reasoning and that these processes directly hinder distorted ethnic beliefs. Overall, these results suggest that improving social-analytic processes related to reflexivity could be an effective intervention to counter those distorted beliefs, such as ethnic disengagement beliefs, associated with discrimination and racial prejudice.

Testing the validity of a self-report scale, author recognition test, and book counting as measures of lifetime exposure to print fiction

We report a study testing the validity of the three most commonly used indicators of lifetime exposure to print fiction, namely a self-report scale, an author recognition test (ART), and book counting, in a sample of older adults (N=306; Mage = 59.29 years, SDage = 7.01). Convergent validity of the self-report scale and book counting was assessed through correlations with the fiction sub-score of the ART; divergent validity of these two indicators was examined via correlations with the non-fiction sub-score of that ART. We also assessed criterion-related validity by testing the degree to which each of the three indicators predicted participants' performance in a vocabulary test. The self-report scale and book counting were significantly more positively associated with the ART fiction sub-score than the ART non-fiction sub-score. Regression analyses, controlling for gender and non-fiction exposure, revealed that the ART fiction sub-score had the highest explanatory power among all indicators under investigation for predicting vocabulary test performance. The present results suggest that only ARTs may have satisfactory levels of both construct and criterion-related validity. Recommendations for the assessment of fiction exposure and future directions are discussed.

Stories in Action

Stories have played a central role in human social and political life for thousands of years. Despite their ubiquity in culture and custom, however, they feature only peripherally in formal government policymaking. Government policy has tended to rely on tools with more predictable responses-incentives, transfers, and prohibitions. We argue that stories can and should feature more centrally in government policymaking. We lay out how stories can make policy more effective, specifying how they complement established policy tools. We provide a working definition of stories' key characteristics, contrasting them with other forms of communication. We trace the evolution of stories from their ancient origins to their role in mediating the impact of modern technologies on society. We then provide an account of the mechanisms underlying stories' impacts on their audiences. We conclude by describing three functions of stories-learning, persuasion, and collective action.

Reading about minds: The social-cognitive potential of narratives

It is often argued that narratives improve social cognition, either by appealing to social-cognitive abilities as we engage with the story world and its characters, or by conveying social knowledge. Empirical studies have found support for both a correlational and a causal link between exposure to (literary, fictional) narratives and social cognition. However, a series of failed replications has cast doubt on the robustness of these claims. Here, we review the existing empirical literature and identify open questions and challenges. An important conclusion of the review is that previous research has given too little consideration to the diversity of narratives, readers, and social-cognitive processes involved in the social-cognitive potential of narratives. We therefore establish a research agenda, proposing that future research should focus on (1) the specific text characteristics that drive the social-cognitive potential of narratives, (2) the individual differences between readers with respect to their sensitivity to this potential, and (3) the various aspects of social cognition that are potentially affected by reading narratives. Our recommendations can guide the design of future studies that will help us understand how, for whom, and in what respect exposure to narratives can advantage social cognition.

Functional Brain Connectivity During Narrative Processing Relates to Transportation and Story Influence

Engaging with narratives involves a complex array of cognitive and affective processes. These processes make stories persuasive in ways that standard arguments are not, though the underlying reasons for this remain unclear. Transportation theory proposes a potential explanation for this: narratives are processed in a way which makes individuals feel immersed in the world of a story, which in turn leads people to resonate emotionally with the events of the story. Recent fMRI studies have shown that the posterior medial cortex (PMC) and anterior insula (AI) play important roles in understanding the meaning of stories and experiencing the feelings they produce. In this study, we aimed to explore the AI’s and PMC’s role in narrative processing by measuring their functional connectivity with the rest of the brain during story listening, and how connectivity changes as a function of narrative transportation and the persuasiveness of the story. We analyzed data from 36 right-handed subjects who listened to two stories, obtained from podcasts, inside the fMRI scanner. After the scan, subjects were asked a series of questions, including a measure of how transported into the story they felt, how likely they would be to donate to causes related to the messages of the stories. We used searchlight multivariate pattern analysis (MVPA) to classify functional connectivity maps using seeds in both the AI and PMC and to compare these maps between participants who differed in transportation and prosocial intention. We found that connectivity to various regions successfully distinguished between high and low ratings on each of these behavioral measures with accuracies over 75%. However, only one pattern of connectivity was consistent across both stories: PMC-inferior frontal gyrus connectivity successfully distinguished high and low ratings of narrative transportation in both stories. All other findings were not consistent across stories. Instead, we found that patterns of connectivity may relate more to the specific content of the story rather than to a universal way in which narratives are processed.

Do Personal Stories Make Patient Decision Aids More Effective? An Update from the International Patient Decision Aids Standards

BACKGROUND

This article evaluates the evidence for the inclusion of patient narratives in patient decision aids (PtDAs). We define patient narratives as stories, testimonials, or anecdotes that provide illustrative examples of the experiences of others that are relevant to the decision at hand.

METHOD

To evaluate the evidence for the effectiveness of narratives in PtDAs, we conducted a narrative scoping review of the literature from January 2013 through June 2019 to identify relevant literature published since the last International Patient Decision Aid Standards (IPDAS) update in 2013. We considered research articles that examined the impact of narratives on relevant outcomes or described relevant theoretical mechanisms.

RESULTS

The majority of the empirical work on narratives did not measure concepts that are typically found in the PtDA literature (e.g., decisional conflict). Yet, a few themes emerged from our review that can be applied to the PtDA context, including the impact of narratives on relevant outcomes (knowledge, behavior change, and psychological constructs), as well as several theoretical mechanisms about how and why narratives work that can be applied to the PtDA context.

CONCLUSION

Based on this evidence update, we suggest that there may be situations when narratives could enhance the effectiveness of PtDAs. The recent theoretical work on narratives has underscored the fact that narratives are a multifaceted construct and should no longer be considered a binary option (include narratives or not). However, the bottom line is that the evidence does not support a recommendation for narratives to be a necessary component of PtDAs.

The Power of the Media on Peace and Reconciliation Processes: Representing Former Enemy Groups as Moral versus Immoral Matters

The efforts of peace-building and reconciliation between historical enemies are faced with many structural and psychological obstacles. Scholars have identified mechanisms that can induce improvements in psychological aspects of intergroup relations, such as intergroup contact. However, establishing direct contact with everyone is impossible. Therefore, the mass media represents an important source through which groups learn about each other. Numerous studies have shown that stereotypical and often negative portrayals of specific social groups through the media produce or reinforce negative intergroup outcomes. In this research, the authors report results from an experimental study conducted in a post-conflict society of Bosnia and Herzegovina ( N = 119). It examined the effects of stereotypical and counter-stereotypical representations of former enemy groups (Bosniaks) through the media on intergroup behavior (reported by Bosnian Serbs). More specifically, in this research the authors explored the effects of representing out-group individuals as immoral (the stereotypical condition) and moral (the counter-stereotypical condition) on specific behavioral tendencies toward the historical enemy group. The results indicate that exposure to primarily moral information about the out-group target facilitated important positive intergroup outcomes. This study extends the literature and research on moral exemplars by demonstrating the effects on relevant intergroup outcomes whilst utilizing current (vs. historical) moral exemplar stories.

Prejudice Reduction: Progress and Challenges

The past decade has seen rapid growth in research that evaluates methods for reducing prejudice. This essay reviews 418 experiments reported in 309 manuscripts from 2007 to 2019 to assess which approaches work best and why. Our quantitative assessment uses meta-analysis to estimate average effects. Our qualitative assessment calls attention to landmark studies that are noteworthy for sustained interventions, imaginative measurement, and transparency. However, 76% of all studies evaluate light touch interventions, the long-term impact of which remains unclear. The modal intervention uses mentalizing as a salve for prejudice. Although these studies report optimistic conclusions, we identify troubling indications of publication bias that may exaggerate effects. Furthermore, landmark studies often find limited effects, which suggests the need for further theoretical innovation or synergies with other kinds of psychological or structural interventions. We conclude that much research effort is theoretically and empirically ill-suited to provide actionable, evidence-based recommendations for reducing prejudice.

Can Bad Be Good? The Attraction of a Darker Self

To avoid threats to the self, people shun comparisons with similar-yet immoral, mentally unstable, or otherwise negatively viewed-others. Despite this prevalent perspective, we consider a contrarian question: Can people be attracted to darker versions of themselves? We propose that with self-threat assuaged, similarity signals self-relevance, which draws people toward those who are similar to them despite negative characteristics. To test this general idea, we explored a prevalent context that may offer a safe haven from self-threat: stories. Using a large-scale proprietary data set from a company with over 232,000 registered users, we demonstrated that people have a preference for villains-unambiguously negative individuals-who are similar to themselves, which suggests that people are attracted to such comparisons in everyday life. Five subsequent lab experiments (N = 1,685) demonstrated when and why similarity results in attraction toward-rather than repulsion from-negative others.

Biased by our imaginings

I propose a new model of implicit bias, according to which implicit biases are constituted by unconscious imaginings. I argue that my model accommodates characteristic features of implicit bias, does not face the problems of the doxastic model, and is uniquely placed to accommodate the structural heterogeneity in the category of implicit bias. Finally I turn to how my view relates to holding people accountable for their biases and what we know about intervention strategies.

On the Usefulness of Narratives: An Interdisciplinary Review and Theoretical Model

Background

How can we use stories from other people to promote better health experiences, improve judgments about health, and increase the quality of medical decisions without introducing bias, systematically persuading the listeners to change their attitudes, or altering behaviors in nonoptimal ways? More practically, should narratives be used in health education, promotion, or behavior change interventions?

Method

In this article, we address these questions by conducting a narrative review of a diverse body of literature on narratives from several disciplines to gain a better understanding about what narratives do, including their role in communication, engagement, recall, persuasion, and health behavior change. We also review broad theories about information processing and persuasion from psychology and more specific models about narrative messaging found in the health communication and marketing literatures to provide insight into the processes by which narratives have their effect on health behavior.

Results

To address major gaps in our theoretical understanding about how narratives work and what effects they will have on health behavior, we propose the Narrative Immersion Model, whose goal is to identify the parameters that predict the specific impact of a particular narrative (e.g. persuade, inform, comfort, etc.) based on the type of narrative message (e.g. process, experience, or outcome narrative). Further, the Narrative Immersion Model describes the magnitude of the effect as increasing through successive layers of engagement with the narrative: interest, identification, and immersion. Finally, the Narrative Immersion Model identifies characteristics of the narrative intervention that encourage greater immersion within a given narrative.

Conclusions

We believe there are important communication gaps in areas areas of behavioral medicine that could be addressed with narratives; however, more work is needed in order to employ narrative messaging systematically. The Narrative Immersion Model advances our theoretical understanding about narrative processing and its subsequent effects on knowledge, attitudes, and behavior.

Metadata for diversity

Purpose

The purpose of this paper is to investigate what metadata elements for access points currently exist to represent diverse library reading materials, either in libraries or from external sources, as well as what metadata elements for access points are currently not present but are necessary to represent diverse library reading materials.

Design/methodology/approach

A field scan of thirteen contemporary metadata schemas identified elements that might serve as potential access points regarding the diversity status of resource creators as well as topical or thematic content. Elements were semantically mapped using a metadata crosswalk to understand the intellectual and conceptual space of the elements. Element definitions and application of controlled vocabularies were also examined where possible to offer an additional context.

Findings

Metadata elements describing gender, occupation, geographic region, audience and age currently exist in many schemas and could potentially be used to offer access to diverse library materials. However, metadata elements necessary to represent racial, ethnic, national and cultural identity are currently not present in specific forms necessary for enabling resource access and collection assessment. The lack of distinct elements contributes to the implicit erasure of marginalized identities.

Originality/value

The search for metadata describing diversity is a first step toward enabling more systematic access to diverse library materials. The need for systematic description of diversity to make visible and promote diverse materials is highlighted in this paper. Though the subject of this paper is library organization systems and, for clarity, uses terms specific to the library profession, the issues present are relevant to all information professionals and knowledge organization systems.

Testing Hypersensitive Responses: Ethnic Minorities Are Not More Sensitive to Microaggressions, They Just Experience Them More Frequently

Racial microaggressions have attracted significant empirical attention and have been associated with profound negative effects. However, some argue against the importance of microaggressions arguing that (some) responses to microaggressions merely reflect “hypersensitivity” to trivial events among certain ethnic minority individuals. Three studies tested this hypersensitivity hypothesis. In two cross-sectional studies with dissimilar samples ( N1 = 130, N2 = 264), ethnic minorities reported experiencing more microaggressions than ethnic majorities did, and microaggressions predicted less life satisfaction. However, contrary to the hypersensitivity hypothesis, minority identity did not moderate this relationship. In a randomized, controlled experiment ( N3 = 114), White and ethnic minority participants reported their positive and negative affect before and after recalling either a microaggression or a control event. Recalling microaggressions reduced positive affect and increased negative affect, but this was also not moderated by minority identity. Implications for the hypersensitivity hypothesis, and microaggressions research, are discussed.

Overcoming Resistance to Change: Using Narratives to Create More Positive Intergroup Attitudes

Researchers and practitioners have proposed numerous methods to reduce prejudice and create more positive attitudes toward members of other groups. However, empirical support for the effectiveness of these methods is mixed at best. Here, we propose that intergroup attitudes tend to be highly resistant to change, and thus, any method aiming to change these attitudes will be effective only if it successfully overcomes this resistance. First, we argue that traditional methods used to promote positive intergroup attitudes are inadequate in this regard. Next, we suggest that narratives are a unique way of overcoming resistance because they create less reactance, transport individuals into a story world, and provide them with social models. We then describe empirical evidence suggesting that narratives are likely to be particularly useful for creating more positive attitudes toward members of other social groups. Finally, we propose a number of empirical and theoretical questions that present challenges for research on narratives and intergroup attitudes.

Harnessing Phenomenological Research to Facilitate Conscientização About Oppressive Lived Experience

This article illustrates how liberation psychology and phenomenological research can work in tandem to raise conscientização (critical consciousness) about unjust societal dynamics, mourn sociopolitical community traumas, and construct empathic bridges among diverse citizens of society. It outlines three ways in which phenomenological researchers can harness their methodologies as an emancipatory tool for oppressed communities. First, I discuss how Steen Halling’s dialogal phenomenological method can build public homeplaces in which members of marginalized communities can gather together to share and gain insight into their oppressed lived experiences. Second, I discuss how Max Van Manen’s existential-phenomenological data interpretation can nurture solidarity among the oppressed and oppressors and demonstrate the ways in which institutionalized oppression dehumanizes all citizens. Third, I encourage phenomenological researchers to disseminate research in artistic formats to evoke compassionate witness among citizen bystanders about oppressive lived experiences. The article concludes by positing that Paulo Freire’s process of emancipation is, essentially, a phenomenological endeavor.

Stories and the Promotion of Social Cognition

Engaging with fictional stories and the characters within them might help us better understand our real-world peers. Because stories are about characters and their interactions, understanding stories might help us to exercise our social cognitive abilities. Correlational studies with children and adults, experimental research, and neuropsychological investigations have all helped develop our understanding of how stories relate to social cognition. However, there remain a number of limitations to the current evidence, some puzzling results, and several unanswered questions that should inspire future research. This review traces multiple lines of evidence tying stories to social cognition and raises numerous critical questions for the field.

Reading Literary Fiction and Theory of Mind: Three Preregistered Replications and Extensions of Kidd and Castano (2013)

Scholars from diverse disciplines have proposed that reading fiction improves intersubjective capacities. Experiments have yielded mixed evidence that reading literary fiction improves performance on the Reading the Mind in the Eyes Test, a test of Theory of Mind. Three preregistered experiments revealed mixed results. Applying the “small telescopes” method developed by Simonsohn revealed two uninformative failures to replicate and one successful replication. On a measure of the importance of intentions to moral judgments, results were more mixed, with one significant effect in the expected direction, one nonsignificant effect, and one significant effect in the unexpected direction. In addition, two experiments yielded support for the exploratory but preregistered hypothesis that characters in popular fiction are perceived as more predictable and stereotypic than those in literary fiction. These findings help clarify the sociocognitive effects of reading literary fiction and refine questions for future research.

Literary Fiction Influences Attitudes Toward Animal Welfare

Literary fiction has been credited with considerable power to improve attitudes toward outgroups. It was even argued that it has been an important factor behind the global decline of violence against various minorities in the last centuries. Could it also help to reduce the human-inflicted suffering of animals? To test this, we studied the attitude toward animal welfare of n = 921 (experimental group) people of both sexes who read a short fragment of an unpublished novel with a motif of the physical abuse of an animal. The control group (n = 912) read a fragment of a similar length but not related to animals. After reading the text all subjects filled out an on-line questionnaire with seven items (camouflaged among many others items) measuring attitudes toward animal welfare. The questionnaire included also demographical questions, such as whether the subject keeps pets. We found that in comparison with the control group, the experimental group was significantly more concerned about animal welfare. This result indicates that literary fiction can influence attitudes toward other species. It is also worth noting that our study is characterized by a high level of ecological validity, i.e. a relatively high extent to which its results can be generalized (or extended) to real-world settings. Due to its specific design, which involved the cooperation of a bestselling author and his publisher, the study approximated the typical conditions in which people read fiction in a remarkably accurate way. Finally, our research has potential practical implications for promoting animal welfare.

Using Video to Increase Gender Bias Literacy Toward Women in Science

Despite evidence that gender biases contribute to the persistent underrepresentation of women in science, technology, engineering, and mathematics, interventions that enhance gender bias literacy about these fields remain rare. The current research tested the effectiveness of two theoretically grounded sets of videos at increasing gender bias literacy as characterized by (a) awareness of bias, (b) knowledge of gender inequity, (c) feelings of efficacy at being able to notice bias, and (d) recognition and confrontation of bias across situations. The narrative videos utilized entertaining stories to illustrate gender bias, while the expert interview videos discussed the same bias during an interview with a psychology professor. The narrative videos increased participants’ immersion in the story and identification with characters, whereas the expert interviews promoted logical thinking and perceptions of being knowledgeable about gender bias facts. Compared with control videos, the narrative and expert interview videos increased awareness of bias (Experiments 1 and 2) and influenced knowledge of gender inequity, self-efficacy beliefs, and the recognition of bias in everyday situations (Experiment 2). However, only the expert interview videos affected participants’ intentions to confront unfair treatment. Additional online materials for this article are available to PWQ subscribers on PWQ’s website at http://pwq.sagepub.com/supplemental

Between Fiction and Reality in Post-Genocide Rwanda: Reflections on a Social-Psychological Media Intervention for Social Change

This article reflects on the potential and challenges of implementing social psychological interventions in the aftermath of genocide, specifically focusing on an education entertainment media campaign in Rwanda. The analysis is based on the author’s experience working with a non-governmental organization in producing "Musekeweya"—a very popular violence prevention and reconciliation radio drama. The article highlights the advantages of using fiction as an effective tool to communicate messages about violence and reconciliation, and provide a safe space to address sensitive topics in post-genocide contexts. In addition, it outlines some of the challenges of translating existing knowledge to interventions that promote reconciliation in specific socio-political settings, such as Rwanda, where the government has implemented a series of programs and policies to achieve unity and reconciliation. The paper ends with a discussion of future directions to further increase social and political psychology’s potential to inform effective social interventions in the aftermath of violence.