Division of Primary Care and Population Health, Stanford University School of Medicine, 960 North San Antonio Road, Suite 101, Los Altos, CA, 94022, USA.
Division of Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, CA, USA.
BMC Med Educ. 2021 Oct 20;21(1):535. doi: 10.1186/s12909-021-02935-x.
Narrative Medicine may mitigate physician burnout by increasing empathy and self-compassion, and by encouraging physicians to deeply connect with patient stories/experiences. However, Narrative Medicine has been difficult to implement on hectic inpatient teaching services that are often the most emotionally taxing for residents.
To evaluate programmatic and learner outcomes of a novel narrative medicine curriculum implementation during inpatient medicine rotations for medical residents. Programmatic outcomes included implementation lessons. Learner outcomes included preliminary understanding of impact on feelings of burnout. Additionally, we developed a generalizable narrative medicine framework for program implementation across institutions.
We developed and implemented a monthly 45-min Narrative Medicine workshop on Stanford's busiest and emotionally-demanding inpatient rotation (medical oncology). Using the Physician Wellbeing Inventory (PWBI, range 1-7; 3-4 = high burnout risk; ≥4, high burnout), we anonymously assessed resident burnout during pre-implementation control year (2017-2018, weeks 1 and 4), and implementation year (2018-2019, weeks 1 and 4). We interviewed program directors and facilitators regarding curriculum implementation challenges/facilitators.
Residents highly rated the narrative medicine curriculum, and the residency program renewed the course for 3 additional years. We identified success factors for programmatic success including time neutrality, control of session, learning climate, building trust, staff partnership, and facilitators training. During control year, resident burnout was initially high (n = 16; mean PBWI = 3.0, SD: 1.1) and increased by the final week (n = 15; PBWI = 3.4, SD: 1.6). During implementation year, resident burnout was initially similar (n = 13; PBWI = 3.1, SD: 1.9) but did not rise as much by rotation end (n = 24; PBWI = 3.3, SD: 1.6). Implementation was underpowered to detect small effect sizes. Based on our our experience and literature review, we propose an educational competency framework potentially helpful to facilitate inpatient narrative medicine workshops, as a blueprint for other institutions.
Inpatient Narrative Medicine is feasible to implement during a challenging inpatient rotation and may have important short-term effects in mitigating burnout rise, with more study needed. We share teaching tools and propose a competency framework which may be useful to support development of inpatient narrative medicine curricula across institutions.
叙事医学可以通过增加同理心和自我同情，以及鼓励医生与患者的故事/经历深入联系，来减轻医生的倦怠感。然而，叙事医学在繁忙的住院教学服务中实施起来很困难，因为这些服务往往对住院医师的情绪压力最大。
评估一种新的叙事医学课程在住院医师内科轮转中的实施对住院医师的项目和学习者结果。项目结果包括实施经验。学习者的结果包括对影响倦怠感的初步理解。此外，我们为跨机构的项目实施开发了一个可推广的叙事医学框架。
我们在斯坦福大学最繁忙和情绪要求最高的住院轮转（肿瘤内科）中开发并实施了一个每月 45 分钟的叙事医学研讨会。使用医生幸福感量表（PWBI，范围 1-7；3-4=高倦怠风险；≥4=高倦怠），我们在实施前的控制年（2017-2018 年，第 1 周和第 4 周）和实施年（2018-2019 年，第 1 周和第 4 周）对住院医师的倦怠感进行匿名评估。我们对课程实施的挑战/促进因素对项目主任和教员进行了访谈。
住院医师对叙事医学课程的评价很高，住院医师项目又延长了 3 年。我们确定了项目成功的因素，包括时间中性、课程控制、学习氛围、建立信任、员工合作和教员培训。在控制年，住院医师的倦怠感最初较高（n=16；平均 PWBI=3.0，SD：1.1），并在最后一周增加（n=15；PWBI=3.4，SD：1.6）。在实施年，住院医师的倦怠感最初相似（n=13；PWBI=3.1，SD：1.9），但到轮转结束时并没有增加那么多（n=24；PWBI=3.3，SD：1.6）。实施的效力不足以检测到较小的效应量。基于我们的经验和文献综述，我们提出了一个教育能力框架，可能有助于促进住院叙事医学研讨会，为其他机构提供蓝图。
在具有挑战性的住院轮班中实施住院叙事医学是可行的，并且可能在减轻倦怠感上升方面有重要的短期效果，还需要更多的研究。我们分享教学工具，并提出一个能力框架，这可能有助于支持跨机构住院叙事医学课程的发展。
