Introduction

Structured Course Template

Narrative Medicine offers a course template for Clinical Distinction that aligns activities with competencies and EPAs and allows the student to do less development in their specialty track. The descriptions below explain the activities and requirements for the course as designed. As always a contract and narrative evaluation must be written by the student. If a student is interested in using these resources but not following the template they should contact the faculty sponsor listed below to discuss their ideas. Resources that are independent study, such as suggested readings can be incorporated into any project without using the template described.

Faculty Sponsor

Elsa Asher MS, CD(DONA)
elsa@elsaasher.com
Office hours by appointment

About Narrative Medicine

While there have been great technical advances in medicine with recognized benefits, there is a growing sense that something has been lost in the practice of contemporary medicine, independent of the type of medicine practiced.

As Gary Hoff, DO writes,

“Medicine stands at a crossroad. Disruptive physician behavior has increased, and patient satisfaction has decreased. A growing body of knowledge demonstrates that the medical humanities assist in the creation of compassionate, resilient physicians. Incorporating medical humanities into the medical school curriculum promotes the development of compassionate, culturally sensitive physicians, and also encourages the development of resilience in health care professionals at a time when internal and external pressures on physicians are increasing.”[1]

We believe that the interaction between a patient and a provider is the interconnected unfolding of multiple narratives, and that attention to this aspect of the encounter enriches and deepens the experience for all involved. It is the understanding of each of our experiences and our shared connection that actually protects us from losing our humanity, our compassion and our love for our work.

As Naomi Rachel Remen, MD notes,

“People who are physicians have been trained to believe that it is a scientific objectivity that makes them most effective in their efforts to understand and resolve the pain that others bring them, and a mental distance that protects them from becoming wounded from this difficult work.”[2]

Narrative Medicine is the practice of three skills: attention, representation and affiliation, as articulated by Rita Charon, MD, PhD. We will utilize practices of close reading of multi-media narratives, listening, writing to a prompt, storytelling and facilitated discussion to engage with themes relevant to many of the Entrustable Physician Activities (EPAs).

[1] Hoff, G., Hirsch, N. J., Means, J. J., & Streyffeler, L. (2014). A call to include medical humanities in the curriculum of colleges of osteopathic medicine and in applicant selection. The Journal of the American Osteopathic Association, 114(10), 798-804.

[2] Remen, R. N. (2002). Kitchen table wisdom: Stories that heal. Pan Australia.

Competencies

The Narrative Medicine Clinical Distinction teaches to many aspects of the following AOA Competencies:

  • Osteopathic Principles and Practice
  • Patient Care
  • Interpersonal and Communication Skills
  • Professionalism
  • Practice-based Learning and Improvement
  • Systems-based Practice

Learning Outcomes

  • Deepen skills of listening, close observation, eliciting a narrative, and responding to the story, with attention to the nuances of power dynamics, multiplicity of the narrative, the ethics in telling another person’s story, and the function of narrative in relation to illness and health.
  • Develop narrative competencies – writing, close reading, self-reflection and practice giving and receiving commentary on written work as a practice in interpersonal exchange, with awareness of the relevance to the health care practitioner-patient relationship.
  • Develop personal insight and emotional literacy that allows for more skillful personal interaction.

Teaching Methods

  • In-class close reading of literature, articles, film, and radio
  • Engaged facilitated discussion of relevant themes
  • Writing in response to a prompt
  • Reading writing aloud in the group
  • Giving and receiving feedback on each other’s writing work

Requirements for Clinical Distinction Students

Accumulate a minimum of 250 points to meet the requirements for the Narrative Medicine Clinical Distinction Specialty Track

  • Complete a Clinical Distinction Contract
  • Complete the Narrative Medicine Elective = 125 points
    • Attend 8 sessions on campus or by eConference
    • Complete Reflective Writing Self Evaluation before each session: ly/NMPreEval
    • Complete Reflective Writing Self Evaluation after each session: ly/NMPostEval
    • Complete Narrative Medicine Course Evaluation
  • Complete Clinical Distinction Narrative Evaluation and exit interview.
  • Accumulate an additional 125 points by completing any of the following:
    • Interview someone (a classmate, provider, faculty, friend, family member) about their experience as a patient, in training, or as a provider, via StoryCorps platform, instructions here: http://blog.ted.com/5-tips-for-conducting-an-interview-with-someone-you-care-about/, download app here: https://storycorps.me/ and write a 2 page reflective writing piece about your experience = 25 points
    • Audit Narrative Medicine CME workshop = 50 points
    • Write a personal or familial illness/disability/health related narrative, 3-5 pages = 25 points — guidelines will be provided upon request
    • Watch/listen to/read a “text” from the lists blow and write 1-2 page analysis = points vary, see below

Texts

Course materials utilized in the Narrative Medicine Elective will be available for download on Blackboard. Clinical Distinction materials are available by request. For a copy of any of the essays, or to borrow one of the books or films (pending availability), please email elsa.asher@tu.edu. The films can also be rented or purchased. If you have any issues accessing materials, please contact the Faculty Sponsor.

“Texts” for Clinical Distinction Students

Radio Episodes = 10 points

Book List = 20 points

  • Pathologies of Power, Paul Farmer (5 chapters)
  • Regarding the Pain of Others, Susan Sontag
  • Illness as Metaphor and AIDS and it’s Metaphor, Susan Sontag
  • Why Be Happy When You Could Be Normal, Jeanette Winterson
  • Stories of Illness and Healing: Women Write Their Bodies, ed. Sayantani DasGupta and Marsha Hurst (5 chapters)
  • Narrative Medicine: Introduction to Illness & Disability Narratives, Rita Charon (5 chapters)
  • Intoxicated by My Illness, Anatole Broyard
  • The Wounded Storyteller, Arthur Frank
  • Tangles, Sarah Levitt
  • Mom’s Cancer, Brian Fies
  • Family Medical Dictionary, Rebecca Brown
  • In the Body of the World, Eve Ensler
  • The Imperative, Alphonso Lingis
  • Why Be Happy When You Could Be Normal, Jeanette Winterson
  • The Cancer Journals, Audre Lorde
  • Are You My Mother?, Alison Bechtel
  • Atlantis, Mark Doty
  • Empathy Exams, Leslie Jamieson

Webinars/Talks = 10 points

Essays = 10 points

  • What’s Wrong with Me?, Meghan O’Rourke
  • Cancerland, Barbara Ehrenreich
  • On Illness, Virginia Woolf
  • Analytic Autoethnography, Leon Anderson

Films = 15 points

  • Beasts of the Southern Wild
  • Still Alice
  • 50/50
  • Obvious Child
  • Google Baby
  • Paternal Instinct
  • Latching On
  • Can We See the Baby Bump Please?
  • Freeheld

Narrative Medicine can also be taken as an elective

This option is not a CD or a rotation but available to first and second year students or students who would like to participate in their “free” time.

Narrative Medicine Elective

The Narrative Medicine Elective will be a combination of clinical students taking it as part of the Narrative Medicine Clinical Distinction, and pre-clinical and clinical students who are taking it as an elective. The course offers pre-clinical and clinical students an opportunity to reframe and add layers of information to patient encounters; to enrich their professional experiences; to process the painful and challenging aspects of clinical encounters; to and to exercise more agency into their still evolving professional identities.

Introduction: Narrative Competence, Narrative Humility

Session 1 — EPA1: Gather a history and perform a physical examination

Session 2 — EPA2: Prioritize a differential diagnosis following a clinical encounter

Session 3 — EPA6: Provide an oral presentation of a clinical encounter

Session 4 — EPA7: Form clinical questions and retrieve evidence to advance patientcare

Session 5 — EPA11: Obtain informed consent for tests and/or procedures

Session 6 — EPA12: Perform general procedures of a physician

Session 7 — EPA13: Identify system failures and contribute to a culture of safety and improvement & EPA10: Recognize a patient requiring urgent or emergent care and initiate evaluation and management

Session 8 — EPA14: Integrate Osteopathic Principles and Practice into your clinical practice

Faculty Sponsors

Elsa Asher MS, CD(DONA)
elsa.asher@tu.edu
Office hours by appointment