Instructor of Medicine, Department of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center.
Assistant Professor of Clinical Medicine, Department of Medicine, Hospital of the University of Pennsylvania.
MedEdPORTAL. 2024 Oct 22;20:11446. doi: 10.15766/mep_2374-8265.11446. eCollection 2024.
Empathy, reflection, and social connectedness are important skills for physician identity development and are increasingly challenged by burnout. Humanities-based interventions like narrative medicine (NM) are emerging in medical education to promote these skills. Only 17% of such initiatives target graduate medical learners. Furthermore, interventions are inconsistent in approach and theory representation. NM uses story-based learning to promote reflection and group discussion. Inspired by narrative learning theory, we developed NM sessions for residents to foster healthy identity development.
Ninety-minute sessions were integrated into curricula for PGY 1-PGY 3 internal medicine-primary care residents at two large academic centers. Sessions involved engagement with a narrative source (stories, poems, art), personal reflection, and group discussion. Topics ranged from burnout to difficult patients. Participants completed anonymous postsession surveys assessing satisfaction, attitudes, and skills.
Fifteen sessions occurred from 2021 to 2023, with three to 10 residents per session. Fifty residents completed between one and four sessions, with 68 survey responses (response rate: 88%). Over 95% ranked 4-5 out of 5 for overall impression ( = 67) and personal value ( = 65) of sessions. Sessions were highly enjoyable ( = 4.8), with mean scores of >4 out of 5 for impact on wellness, appreciation of work values, social connectedness, and patient care.
NM sessions demonstrated measurable improvements in several domains of professional performance including wellness, job satisfaction, and patient care, while promoting camaraderie and emotion processing. Our materials offer tremendous potential for promoting healthy identity formation.
同理心、反思和社会联系是医师身份发展的重要技能，而这些技能正日益受到职业倦怠的挑战。人文学科为基础的干预措施，如叙事医学（NM），正在医学教育中出现，以促进这些技能。只有 17%的此类举措针对的是研究生医学生。此外，干预措施在方法和理论表现上不一致。NM 使用基于故事的学习来促进反思和小组讨论。受叙事学习理论的启发，我们为住院医师开发了 NM 课程，以促进健康的身份发展。
90 分钟的课程被整合到两个大型学术中心的 PGY 1-PGY 3 内科-初级保健住院医师的课程中。课程包括与叙事源（故事、诗歌、艺术）的互动、个人反思和小组讨论。主题从职业倦怠到困难的病人。参与者完成了匿名的课后调查，评估满意度、态度和技能。
从 2021 年到 2023 年，共进行了 15 次课程，每次课程有 3 到 10 名住院医师参加。50 名住院医师完成了一到四次课程，共有 68 份调查答复（答复率：88%）。超过 95%的人对课程的整体印象（=67）和个人价值（=65）评为 4-5 分。课程非常有趣（=4.8），对幸福感、对工作价值观的欣赏、社会联系和病人护理的影响的平均得分超过 4 分/5 分。
NM 课程在几个专业表现领域显示出可衡量的改善，包括幸福感、工作满意度和病人护理，同时促进了同志情谊和情绪处理。我们的材料为促进健康的身份形成提供了巨大的潜力。
